Healthcare Provider Details

I. General information

NPI: 1265164214
Provider Name (Legal Business Name): TANNER JAMES RISCOE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 WORNALL RD
KANSAS CITY MO
64111-3220
US

IV. Provider business mailing address

4401 WORNALL RD
KANSAS CITY MO
64111-3220
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-2000
  • Fax: 816-932-2000
Mailing address:
  • Phone: 816-932-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025008826
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number327868
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2025008826
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOT022170
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: