Healthcare Provider Details

I. General information

NPI: 1306642822
Provider Name (Legal Business Name): CARLY RENE THOMAS WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9119 W 74TH ST STE 300
OVERLAND PARK KS
66204-2229
US

IV. Provider business mailing address

8716 PARIS AVE
KANSAS CITY MO
64153-1559
US

V. Phone/Fax

Practice location:
  • Phone: 913-677-3113
  • Fax: 913-677-4514
Mailing address:
  • Phone: 913-449-2085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number53-84081-042
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number53-84081-042
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: