Healthcare Provider Details

I. General information

NPI: 1063297810
Provider Name (Legal Business Name): PRISCILLAH WANJIRU NJOROGE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W TRUMAN RD
INDEPENDENCE MO
64050-3434
US

IV. Provider business mailing address

1401 W TRUMAN RD
INDEPENDENCE MO
64050-3434
US

V. Phone/Fax

Practice location:
  • Phone: 816-833-0524
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023032941
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2023032941
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-82249-051
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-82249-051
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: