Healthcare Provider Details

I. General information

NPI: 1679087423
Provider Name (Legal Business Name): LIZY MARY KOCHIPILLAI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10977 GRANADA LN STE 105
LEAWOOD KS
66211-1415
US

IV. Provider business mailing address

PO BOX 875743
KANSAS CITY MO
64187-5743
US

V. Phone/Fax

Practice location:
  • Phone: 913-215-5008
  • Fax: 816-447-3960
Mailing address:
  • Phone: 816-332-7280
  • Fax: 816-447-3932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-77856
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: