Healthcare Provider Details

I. General information

NPI: 1306380886
Provider Name (Legal Business Name): HEATHER OTWELL APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 PARK ST
LENEXA KS
66215-3353
US

IV. Provider business mailing address

9100 PARK ST
LENEXA KS
66215-3353
US

V. Phone/Fax

Practice location:
  • Phone: 877-279-5960
  • Fax: 855-916-1997
Mailing address:
  • Phone: 877-279-5960
  • Fax: 855-916-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77480
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: