Healthcare Provider Details

I. General information

NPI: 1619668845
Provider Name (Legal Business Name): NATASHA GRIFFITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12118 W 55TH ST
SHAWNEE KS
66216-1305
US

IV. Provider business mailing address

26136 US HIGHWAY 59
FAIRFAX MO
64446-9105
US

V. Phone/Fax

Practice location:
  • Phone: 913-717-8064
  • Fax:
Mailing address:
  • Phone: 660-686-2211
  • Fax: 660-686-2618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53-82196-062
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2023024822
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: