Healthcare Provider Details

I. General information

NPI: 1467193771
Provider Name (Legal Business Name): NATALIE DANIELLE NIETO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 09/14/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 913-696-8220
  • Fax:
Mailing address:
  • Phone: 913-696-8220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number05-51758
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: