Healthcare Provider Details

I. General information

NPI: 1144565433
Provider Name (Legal Business Name): CALLIE M CALLAHAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 PARKER AVE
OSAWATOMIE KS
66064-1703
US

IV. Provider business mailing address

36123 SCHOOLCRAFT RD
LIVONIA MI
48150-1216
US

V. Phone/Fax

Practice location:
  • Phone: 913-660-1616
  • Fax:
Mailing address:
  • Phone: 913-660-1616
  • Fax: 913-660-1664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2013001553
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number53-75761-021
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: