Healthcare Provider Details

I. General information

NPI: 1699522839
Provider Name (Legal Business Name): ALYSSA HANNON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 E NORTH AVE
BELTON MO
64012-5109
US

IV. Provider business mailing address

PO BOX 7411901
CHICAGO IL
60674-1901
US

V. Phone/Fax

Practice location:
  • Phone: 816-251-5765
  • Fax: 816-251-5766
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-84338-012
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number13-151652-012
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: