Healthcare Provider Details

I. General information

NPI: 1336591643
Provider Name (Legal Business Name): KELLE LAWSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W AUBERRY GRV
JAMESPORT MO
64648-7189
US

IV. Provider business mailing address

400 SW LONGVIEW BLVD STE 200
LEES SUMMIT MO
64081-2116
US

V. Phone/Fax

Practice location:
  • Phone: 660-684-6252
  • Fax:
Mailing address:
  • Phone: 913-215-5008
  • Fax: 913-297-1202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016022495
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: