Healthcare Provider Details

I. General information

NPI: 1710655436
Provider Name (Legal Business Name): AAKSHI PRAKASH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5195 W 75TH ST
PRAIRIE VILLAGE KS
66208-4401
US

IV. Provider business mailing address

5195 W 75TH ST
PRAIRIE VILLAGE KS
66208-4401
US

V. Phone/Fax

Practice location:
  • Phone: 785-341-1183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number53-80033-111
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2021006049
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: