Healthcare Provider Details

I. General information

NPI: 1508849118
Provider Name (Legal Business Name): NELSON EDWIN JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 BLUE PKWY
KANSAS CITY MO
64130-2866
US

IV. Provider business mailing address

3800 BLUE PKWY
KANSAS CITY MO
64130-2866
US

V. Phone/Fax

Practice location:
  • Phone: 816-923-5800
  • Fax:
Mailing address:
  • Phone: 816-923-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number35506
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35506
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: