Healthcare Provider Details

I. General information

NPI: 1215357413
Provider Name (Legal Business Name): MRS. FELICIA C BURNS-SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 W 36TH AVE
KANSAS CITY KS
66103-2107
US

IV. Provider business mailing address

2205 W 36TH AVE
KANSAS CITY KS
66103-2107
US

V. Phone/Fax

Practice location:
  • Phone: 913-956-5620
  • Fax: 913-362-0431
Mailing address:
  • Phone: 913-956-5620
  • Fax: 913-362-0431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number14-103842-122
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: