Healthcare Provider Details

I. General information

NPI: 1487261673
Provider Name (Legal Business Name): CHARLES Q VIELHAUER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 PARALLEL PKWY
KANSAS CITY KS
66112-3607
US

IV. Provider business mailing address

17810 W 83RD TER
LENEXA KS
66219-8077
US

V. Phone/Fax

Practice location:
  • Phone: 913-596-4000
  • Fax:
Mailing address:
  • Phone: 816-416-0541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-79497-042
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020029105
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number53-79497-042
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: