Healthcare Provider Details

I. General information

NPI: 1316200132
Provider Name (Legal Business Name): ELLEN EKUASE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 DR MARTIN LUTHER KING JR BLVD
KANSAS CITY MO
64130
US

IV. Provider business mailing address

3801 DR MARTIN LUTHER KING JR BLVD
KANSAS CITY MO
64130-2807
US

V. Phone/Fax

Practice location:
  • Phone: 816-923-5800
  • Fax:
Mailing address:
  • Phone: 816-923-5800
  • Fax: 816-922-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2012016695
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2003010413
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: