Healthcare Provider Details

I. General information

NPI: 1275146805
Provider Name (Legal Business Name): RACHEL E FRACASSA CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4831 ANTIOCH RD
SHAWNEE KS
66203-1310
US

IV. Provider business mailing address

10317 W 48TH TER
SHAWNEE KS
66203-1122
US

V. Phone/Fax

Practice location:
  • Phone: 816-838-1121
  • Fax: 913-395-0584
Mailing address:
  • Phone: 816-838-1121
  • Fax: 913-395-0584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM26081065
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: