Healthcare Provider Details

I. General information

NPI: 1851795090
Provider Name (Legal Business Name): EZENWA KEVIN OSUALA ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

4600 COLLEGE BLVD STE 103
OVERLAND PARK KS
66211-1606
US

V. Phone/Fax

Practice location:
  • Phone: 816-698-7000
  • Fax:
Mailing address:
  • Phone: 913-215-5008
  • Fax: 913-297-1202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110032
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014034210
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: