Healthcare Provider Details

I. General information

NPI: 1487039319
Provider Name (Legal Business Name): NICOLE BEBERMEYER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 08/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD
KANSAS CITY KS
66160-8500
US

IV. Provider business mailing address

3901 RAINBOW BLVD
KANSAS CITY KS
66160-8500
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-112047-101
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number76884
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: