Healthcare Provider Details

I. General information

NPI: 1760871487
Provider Name (Legal Business Name): ANNE WATT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2015
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10977 GRANADA LN
LEAWOOD KS
66211-1468
US

IV. Provider business mailing address

15307 W 80TH TER
LENEXA KS
66219-1530
US

V. Phone/Fax

Practice location:
  • Phone: 816-822-0050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76504-011
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014042978
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: