Healthcare Provider Details

I. General information

NPI: 1265088959
Provider Name (Legal Business Name): LISA ANN WHITFIELD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2019
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 RAVENHILL DR
ATCHISON KS
66002-9204
US

IV. Provider business mailing address

8651 NE 97TH ST
KANSAS CITY MO
64157-7617
US

V. Phone/Fax

Practice location:
  • Phone: 913-367-2131
  • Fax:
Mailing address:
  • Phone: 816-935-6301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019040553
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2013028161
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-79055
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: