Healthcare Provider Details

I. General information

NPI: 1679546147
Provider Name (Legal Business Name): NANCY J. WASHBURN ANP-BC, AOCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY J. DAVIS

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 W 110TH ST
OVERLAND PARK KS
66210-4045
US

IV. Provider business mailing address

11300 CORPORATE AVE
LENEXA KS
66219-1374
US

V. Phone/Fax

Practice location:
  • Phone: 913-574-2650
  • Fax: 913-574-2769
Mailing address:
  • Phone: 913-574-2800
  • Fax: 913-574-2336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number089297
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number44830
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number81691
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number089297
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: