Healthcare Provider Details

I. General information

NPI: 1023761939
Provider Name (Legal Business Name): ANDREW QUINN AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 WORNALL RD STE 530
KANSAS CITY MO
64111-5942
US

IV. Provider business mailing address

901 E 104TH ST
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-2836
  • Fax: 816-932-9868
Mailing address:
  • Phone: 816-932-2836
  • Fax: 816-932-9868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number53-81058-071
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2022017081
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2014022787
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: