Healthcare Provider Details

I. General information

NPI: 1063066637
Provider Name (Legal Business Name): ANAYA TINA KOLE PMHNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 W 110TH ST STE 700
OVERLAND PARK KS
66210-2332
US

IV. Provider business mailing address

4901 ALDEN ST
SHAWNEE KS
66216-5164
US

V. Phone/Fax

Practice location:
  • Phone: 816-824-7349
  • Fax:
Mailing address:
  • Phone: 816-824-7349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number2017002712
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2019043204
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-79161-012
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-79161-012
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: