Healthcare Provider Details

I. General information

NPI: 1811762149
Provider Name (Legal Business Name): ANNA VICTORIA HENRY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OLATHE BLVD LEVEL 5, SUITE D E F
KANSAS CITY KS
66160-8505
US

IV. Provider business mailing address

2000 OLATHE BLVD LEVEL 5, SUITE D E F
KANSAS CITY KS
66160-8505
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-9600
  • Fax:
Mailing address:
  • Phone: 913-588-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-82683
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: