Healthcare Provider Details

I. General information

NPI: 1952032054
Provider Name (Legal Business Name): MOKSCARE FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7721 QUIVIRA RD
LENEXA KS
66216-3401
US

IV. Provider business mailing address

7721 QUIVIRA RD
LENEXA KS
66216-3401
US

V. Phone/Fax

Practice location:
  • Phone: 913-248-2838
  • Fax:
Mailing address:
  • Phone: 913-248-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NEEMA TITUS MSHANA
Title or Position: OFFICE MANAGER
Credential:
Phone: 913-706-2508