Healthcare Provider Details

I. General information

NPI: 1992446751
Provider Name (Legal Business Name): KRYSTENE WRAY WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 W 119TH ST STE 225
OVERLAND PARK KS
66209-3721
US

IV. Provider business mailing address

4400 BROADWAY BLVD STE 302
KANSAS CITY MO
64111-3342
US

V. Phone/Fax

Practice location:
  • Phone: 913-601-4020
  • Fax: 913-601-4022
Mailing address:
  • Phone: 816-931-9344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2021041119
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: