Healthcare Provider Details

I. General information

NPI: 1356771729
Provider Name (Legal Business Name): RUTH O OGUNNIYI ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUTH AWONIYI ANP

II. Dates (important events)

Enumeration Date: 11/20/2013
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9229 WARD PKWY STE 380
KANSAS CITY MO
64114-5471
US

IV. Provider business mailing address

PO BOX 23340
SAINT LOUIS MO
63156-3340
US

V. Phone/Fax

Practice location:
  • Phone: 816-319-4785
  • Fax: 855-299-2184
Mailing address:
  • Phone: 314-851-1000
  • Fax: 314-851-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2013006670
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: