Healthcare Provider Details

I. General information

NPI: 1104454057
Provider Name (Legal Business Name): SUSAN EILEEN FESSLER APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 W MAIN ST
BOWLING GREEN MO
63334-1049
US

IV. Provider business mailing address

7202 N FARLEY AVE
KANSAS CITY MO
64158-1012
US

V. Phone/Fax

Practice location:
  • Phone: 573-324-2216
  • Fax:
Mailing address:
  • Phone: 888-865-0960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020004949
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: