Healthcare Provider Details

I. General information

NPI: 1356099691
Provider Name (Legal Business Name): SAMANTHA A. RUDER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4119 NW BARRY RD
KANSAS CITY MO
64154-1100
US

IV. Provider business mailing address

4119 NW BARRY RD
KANSAS CITY MO
64154-1100
US

V. Phone/Fax

Practice location:
  • Phone: 816-452-4488
  • Fax: 816-705-3660
Mailing address:
  • Phone: 816-452-4488
  • Fax: 816-705-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1161910
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberGAA-NP00065
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2025015135
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: