Healthcare Provider Details

I. General information

NPI: 1649965633
Provider Name (Legal Business Name): ELIZABETH WILLENS DNP, APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH CAPPO DNP, APRN, PMHNP

II. Dates (important events)

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

III. Provider practice location address

8629 BLUEJACKET ST
LENEXA KS
66214-1604
US

IV. Provider business mailing address

8629 BLUEJACKET ST
LENEXA KS
66214-1604
US

V. Phone/Fax

Practice location:
  • Phone: 913-677-3553
  • Fax: 913-677-3282
Mailing address:
  • Phone: 913-677-3553
  • Fax: 913-677-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-82076-082
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: