Healthcare Provider Details

I. General information

NPI: 1528894680
Provider Name (Legal Business Name): FEA KOWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 FALL CREEK DR
BELTON MO
64012-7807
US

IV. Provider business mailing address

511 FALL CREEK DR
BELTON MO
64012-7807
US

V. Phone/Fax

Practice location:
  • Phone: 816-217-1688
  • Fax:
Mailing address:
  • Phone: 816-217-1688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024014460
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: