Healthcare Provider Details

I. General information

NPI: 1770903114
Provider Name (Legal Business Name): SUSAN KAY CLAVETTE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 W 95TH ST STE 210
OVERLAND PARK KS
66212-2249
US

IV. Provider business mailing address

7171 W 95TH ST STE 210
OVERLAND PARK KS
66212-2249
US

V. Phone/Fax

Practice location:
  • Phone: 913-210-6005
  • Fax:
Mailing address:
  • Phone: 913-210-6005
  • Fax: 913-210-6008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number76322
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: