Healthcare Provider Details

I. General information

NPI: 1063335404
Provider Name (Legal Business Name): MS. MICHELLE SOUSLEY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 NORTHERN AVE
KANSAS CITY MO
64133-1593
US

IV. Provider business mailing address

4251 NORTHERN AVE
KANSAS CITY MO
64133-1593
US

V. Phone/Fax

Practice location:
  • Phone: 816-922-2850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number2004017806
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: