Healthcare Provider Details

I. General information

NPI: 1073597324
Provider Name (Legal Business Name): TRISHA PROSSICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 W 151ST STREET SUITE 100
OLATHE KS
66061
US

IV. Provider business mailing address

153 W 151ST STREET SUITE 100
OLATHE KS
66061-5300
US

V. Phone/Fax

Practice location:
  • Phone: 913-764-1125
  • Fax: 913-764-1186
Mailing address:
  • Phone: 913-764-1125
  • Fax: 913-764-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number04-31231
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number0431231
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: