Healthcare Provider Details

I. General information

NPI: 1578519690
Provider Name (Legal Business Name): CHARLES RICHARD MORALES II ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 MISSION RD SUITE 350
PRAIRIE VILLAGE KS
66208-3006
US

IV. Provider business mailing address

7301 MISSION RD SUITE 350
PRAIRIE VILLAGE KS
66208-3006
US

V. Phone/Fax

Practice location:
  • Phone: 913-642-2100
  • Fax: 913-642-2127
Mailing address:
  • Phone: 913-642-2100
  • Fax: 913-642-2127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number45864
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: