Healthcare Provider Details

I. General information

NPI: 1699624924
Provider Name (Legal Business Name): EMILIE KAY WIDER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 ROCKHURST RD
KANSAS CITY MO
64110-2508
US

IV. Provider business mailing address

832 SW CUTTER LN
LEES SUMMIT MO
64081-1782
US

V. Phone/Fax

Practice location:
  • Phone: 816-501-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2026002590
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: