Healthcare Provider Details

I. General information

NPI: 1134953193
Provider Name (Legal Business Name): ANDREW FUNK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11120 W 65TH ST
SHAWNEE KS
66203-5504
US

IV. Provider business mailing address

11120 W 65TH ST
SHAWNEE KS
66203-5504
US

V. Phone/Fax

Practice location:
  • Phone: 913-826-4100
  • Fax:
Mailing address:
  • Phone: 913-826-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14520
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: