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NPI Code Detail

MEDICARE: CRYSTAL ANN WEKENBORG FNP

MEDICARE: CRYSTAL ANN WEKENBORG FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner124573MO

General Provider Information

NPI Number : 1427054691
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL ANN WEKENBORG FNP
Provider Business Mailing Address
First Line : PO BOX 801143
Second Line :
City : KANSAS CITY
State : MO
Zip : 64180-1143
Country : US
Telephone Number : 573-331-5583
Fax Number : 573-331-5079
Provider Business Practice Location Address
First Line : 2130 E JACKSON BLVD
Second Line :
City : JACKSON
State : MO
Zip : 63755-2907
Country : US
Telephone Number : 573-243-3115
Fax Number : 573-243-4700
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 03/04/2021

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Directions to “ CRYSTAL ANN WEKENBORG FNP” Practice Location

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