Healthcare Provider Details

I. General information

NPI: 1194684704
Provider Name (Legal Business Name): ELIZABETH KEPHART FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NW R D MIZE RD
BLUE SPRINGS MO
64014-2513
US

IV. Provider business mailing address

784 NW 1621ST RD
BATES CITY MO
64011-8395
US

V. Phone/Fax

Practice location:
  • Phone: 816-228-5900
  • Fax:
Mailing address:
  • Phone: 816-456-1314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025098626
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: