Healthcare Provider Details

I. General information

NPI: 1427698224
Provider Name (Legal Business Name): MICHELE DUCKETT AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 E 39TH ST S STE 220
INDEPENDENCE MO
64057-2305
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 816-461-6837
  • Fax:
Mailing address:
  • Phone: 913-222-9779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number2007005141
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number14-120092-122
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number53-81698-122
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2020002094
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: