Healthcare Provider Details

I. General information

NPI: 1215848130
Provider Name (Legal Business Name): TRACI M RISNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 COLLEGE BLVD STE B
OVERLAND PARK KS
66211-1615
US

IV. Provider business mailing address

11754 S DEER RUN ST
OLATHE KS
66061-2977
US

V. Phone/Fax

Practice location:
  • Phone: 913-283-7704
  • Fax:
Mailing address:
  • Phone: 618-975-9373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number05316
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: