Healthcare Provider Details

I. General information

NPI: 1184269532
Provider Name (Legal Business Name): SIMON KINUTHIA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W ELM ST
OLATHE KS
66061-4008
US

IV. Provider business mailing address

1700 NE 94TH ST
KANSAS CITY MO
64155-2545
US

V. Phone/Fax

Practice location:
  • Phone: 816-878-8387
  • Fax:
Mailing address:
  • Phone: 816-878-8387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number2019035277
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019035277
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number53-84352-122
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: