Healthcare Provider Details

I. General information

NPI: 1053359091
Provider Name (Legal Business Name): DAWN LEANNE VIETS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 COPPER OAKS DR
CARL JUNCTION MO
64834-8444
US

IV. Provider business mailing address

312 COPPER OAKS DR
CARL JUNCTION MO
64834-8444
US

V. Phone/Fax

Practice location:
  • Phone: 816-260-5857
  • Fax:
Mailing address:
  • Phone: 816-260-5857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number81603
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberNNP 118354
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier425221413
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 2
Identifier100344790B
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: