Healthcare Provider Details

I. General information

NPI: 1851857130
Provider Name (Legal Business Name): ATIYA JUNIUS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17065 S. 71 HIGHWAY
BELTON MO
64012
US

IV. Provider business mailing address

17065 S. 71 HIGHWAY
BELTON MO
64012
US

V. Phone/Fax

Practice location:
  • Phone: 816-348-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2014022824
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019005034
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: