Healthcare Provider Details

I. General information

NPI: 1467315986
Provider Name (Legal Business Name): DEVOTED MEDICAL KS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12345 W 95TH ST FL 2
LENEXA KS
66215-3853
US

IV. Provider business mailing address

12345 W 95TH ST FL 2
LENEXA KS
66215-3853
US

V. Phone/Fax

Practice location:
  • Phone: 866-849-0692
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CELY COURTNEY
Title or Position: PRACTICE OPERATIONS
Credential:
Phone: 866-849-0692