Healthcare Provider Details

I. General information

NPI: 1922561729
Provider Name (Legal Business Name): ANNE MARIE FARRELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE MARIE JACQUIN

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 01/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 E 39TH ST S STE 200
INDEPENDENCE MO
64057-2358
US

IV. Provider business mailing address

19550 E 39TH ST S STE 200
INDEPENDENCE MO
64057-2358
US

V. Phone/Fax

Practice location:
  • Phone: 816-350-4200
  • Fax:
Mailing address:
  • Phone: 816-350-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number14-148222-021
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2011023599
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019007201
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: