Healthcare Provider Details

I. General information

NPI: 1366478133
Provider Name (Legal Business Name): TAMARA L. MCGUIRE ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 S 4TH ST
LEAVENWORTH KS
66048-5043
US

IV. Provider business mailing address

1000 CARONDELET DR PROVIDER ENROLLMENT
KANSAS CITY MO
64114
US

V. Phone/Fax

Practice location:
  • Phone: 913-680-6000
  • Fax:
Mailing address:
  • Phone: 816-943-5744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number133516
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2012041460
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number45991
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2013028356
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: