Healthcare Provider Details

I. General information

NPI: 1629871298
Provider Name (Legal Business Name): KIRA ANGLEN FNP-BC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N 2ND ST
CLINTON MO
64735-1297
US

IV. Provider business mailing address

1607 SE ROYAL ST
OAK GROVE MO
64075-9236
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-5511
  • Fax:
Mailing address:
  • Phone: 660-651-0992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025009947
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: