Healthcare Provider Details

I. General information

NPI: 1780403337
Provider Name (Legal Business Name): NYEMAH ETIENNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E 18TH ST
KANSAS CITY MO
64127-2602
US

IV. Provider business mailing address

2700 E 18TH ST
KANSAS CITY MO
64127-2602
US

V. Phone/Fax

Practice location:
  • Phone: 816-517-8305
  • Fax:
Mailing address:
  • Phone: 816-517-8305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2024036976
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: