Healthcare Provider Details

I. General information

NPI: 1881334381
Provider Name (Legal Business Name): NICHOLAS WAYNE YEISLEY MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 LEES SUMMIT RD
KANSAS CITY MO
64139-1236
US

IV. Provider business mailing address

1811 S NORWOOD AVE
INDEPENDENCE MO
64052-3939
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-4862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2024000219
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: