Healthcare Provider Details

I. General information

NPI: 1538254198
Provider Name (Legal Business Name): JOHNNA L FREEMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19600 E 39TH ST S
INDEPENDENCE MO
64057-2301
US

IV. Provider business mailing address

19600 E 39TH ST S
INDEPENDENCE MO
64057-2301
US

V. Phone/Fax

Practice location:
  • Phone: 816-698-8153
  • Fax: 816-698-8165
Mailing address:
  • Phone: 816-698-8153
  • Fax: 816-698-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9781
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number45376
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: