Healthcare Provider Details

I. General information

NPI: 1144032558
Provider Name (Legal Business Name): MR. IAN MCCOMBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 KESSLER ST STE 202
MERRIAM KS
66204-2553
US

IV. Provider business mailing address

6010 W 58TH ST
MISSION KS
66202-2632
US

V. Phone/Fax

Practice location:
  • Phone: 913-632-9480
  • Fax:
Mailing address:
  • Phone: 913-568-3924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-84185
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2019021458
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: