Healthcare Provider Details

I. General information

NPI: 1225921737
Provider Name (Legal Business Name): ANISSA RACHEL EDMONDSON CHRISTIAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANISSA RACHEL EDMONDSON RN

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CAMBRIDGE ST
KANSAS CITY KS
66160-8501
US

IV. Provider business mailing address

9533 RIGGS ST
OVERLAND PARK KS
66212-1539
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1227
  • Fax:
Mailing address:
  • Phone: 706-508-8820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number53-83818-052
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: