Healthcare Provider Details

I. General information

NPI: 1972047629
Provider Name (Legal Business Name): CRISTY DAWN O'CONNELL APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6511 W 119TH ST
OVERLAND PARK KS
66209-2001
US

IV. Provider business mailing address

6511 W 119TH ST
OVERLAND PARK KS
66209-2001
US

V. Phone/Fax

Practice location:
  • Phone: 913-912-8411
  • Fax: 913-308-7550
Mailing address:
  • Phone: 913-912-8411
  • Fax: 913-308-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-53-85394-082
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: