Healthcare Provider Details

I. General information

NPI: 1174415905
Provider Name (Legal Business Name): MARY CHARLENE RAMSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19509 E 9TH ST S
INDEPENDENCE MO
64056-3091
US

IV. Provider business mailing address

2763 MEADOW CHURCH RD STE 110
DULUTH GA
30097-4989
US

V. Phone/Fax

Practice location:
  • Phone: 816-406-8588
  • Fax:
Mailing address:
  • Phone: 816-441-2272
  • Fax: 877-874-2461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number089346
License Number StateMO

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: