Healthcare Provider Details

I. General information

NPI: 1770997470
Provider Name (Legal Business Name): MONICA THIELEN AGACNP BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 06/10/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 KESSLER ST STE 205
MERRIAM KS
66204-2553
US

IV. Provider business mailing address

7450 KESSLER ST STE 205
MERRIAM KS
66204-2553
US

V. Phone/Fax

Practice location:
  • Phone: 913-632-9810
  • Fax: 913-632-9828
Mailing address:
  • Phone: 913-632-9810
  • Fax: 913-632-9828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-76283
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number53 76283
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: