MEDICARE: ELIZABETH ANNE SMITH NP

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
1	363LF0000X	Family Nurse Practitioner	2011032977	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2011032977	OTHER	MO	FNP LICENSE

General Provider Information

NPI Number	:	1912282864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANNE SMITH NP

Provider Business Mailing Address
First Line	:	2609 GLENN HENDREN DR
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-3313
Country	:	US
Telephone Number	:	816-781-7730
Fax Number	:	816-415-1886

Provider Business Practice Location Address
First Line	:	8300 N CHURCH RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64158-1104
Country	:	US
Telephone Number	:	816-407-2300
Fax Number	:	816-407-2301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2011
Last Update Date	:	04/16/2019

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