Healthcare Provider Details

I. General information

NPI: 1487218913
Provider Name (Legal Business Name): DANIELLE SMITH MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 LIMIT ST
LEAVENWORTH KS
66048
US

IV. Provider business mailing address

390 LIMIT ST
LEAVENWORTH KS
66048-4525
US

V. Phone/Fax

Practice location:
  • Phone: 913-651-2323
  • Fax:
Mailing address:
  • Phone: 913-651-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number79300
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5379300061
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number13133993061
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2016001476
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: