Healthcare Provider Details

I. General information

NPI: 1548165863
Provider Name (Legal Business Name): CRAIG HENRY FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6345 LONG AVE
SHAWNEE KS
66216-2504
US

IV. Provider business mailing address

6207 N BELL ST
KANSAS CITY MO
64151-4844
US

V. Phone/Fax

Practice location:
  • Phone: 913-631-6400
  • Fax:
Mailing address:
  • Phone: 816-519-6290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF01260614
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: