Healthcare Provider Details

I. General information

NPI: 1881561595
Provider Name (Legal Business Name): ELAINE MARIE GEBHARDT FNP STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELAINE MARIE GRANDE

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date: 10/20/2025
Reactivation Date: 12/19/2025

III. Provider practice location address

11735 CAENEN ST
OVERLAND PARK KS
66210-2731
US

IV. Provider business mailing address

11735 CAENEN ST
OVERLAND PARK KS
66210-2731
US

V. Phone/Fax

Practice location:
  • Phone: 913-472-8024
  • Fax:
Mailing address:
  • Phone: 913-472-8024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-151106-111
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: