Healthcare Provider Details

I. General information

NPI: 1871411165
Provider Name (Legal Business Name): KRYSTLE DWYER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/07/2026
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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-85841-121
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: