Healthcare Provider Details

I. General information

NPI: 1336535434
Provider Name (Legal Business Name): KELSEY WYKOFF CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOLMES ST
KANSAS CITY MO
64108-2640
US

IV. Provider business mailing address

2301 HOLMES ST
KANSAS CITY MO
64108-2640
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-1100
  • Fax:
Mailing address:
  • Phone: 816-404-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number14-104309-061
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2007022222
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2015018024
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: