Healthcare Provider Details

I. General information

NPI: 1073498614
Provider Name (Legal Business Name): KAITLYN TRACHSEL CPNP - PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN TAMBKE CPNP - PC

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65212-1000
US

IV. Provider business mailing address

PO BOX 843966
KANSAS CITY MO
64184-3966
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-4141
  • Fax:
Mailing address:
  • Phone: 573-884-3300
  • Fax: 573-884-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2025037520
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2020025672
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: