Healthcare Provider Details

I. General information

NPI: 1538926936
Provider Name (Legal Business Name): ABIGAIL LEA HUTSON ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 W 119TH ST
OVERLAND PARK KS
66209-3753
US

IV. Provider business mailing address

13725 METCALF AVE # 403
OVERLAND PARK KS
66223-7899
US

V. Phone/Fax

Practice location:
  • Phone: 913-498-6000
  • Fax:
Mailing address:
  • Phone: 913-498-8787
  • Fax: 913-498-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2015003161
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2024007947
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: