Healthcare Provider Details

I. General information

NPI: 1659787281
Provider Name (Legal Business Name): TRISTA CALHOUN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 W 62ND ST
MERRIAM KS
66203-3220
US

IV. Provider business mailing address

36123 SCHOOLCRAFT RD
LIVONIA MI
48150-1216
US

V. Phone/Fax

Practice location:
  • Phone: 913-384-0800
  • Fax:
Mailing address:
  • Phone: 913-660-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014011108
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number76674
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: