Healthcare Provider Details

I. General information

NPI: 1225598170
Provider Name (Legal Business Name): PRISCILLIA ADAUGO OBASI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W 75TH ST
KANSAS CITY MO
64114-5738
US

IV. Provider business mailing address

6807 E 144TH PL
GRANDVIEW MO
64030-4140
US

V. Phone/Fax

Practice location:
  • Phone: 816-361-4668
  • Fax:
Mailing address:
  • Phone: 816-878-1893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018041864
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: