Healthcare Provider Details

I. General information

NPI: 1215742325
Provider Name (Legal Business Name): ERICA BELGRAVE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 E LINWOOD BLVD
KANSAS CITY MO
64128-2226
US

IV. Provider business mailing address

11040 E 54TH ST
RAYTOWN MO
64133-2985
US

V. Phone/Fax

Practice location:
  • Phone: 816-922-3399
  • Fax:
Mailing address:
  • Phone: 816-591-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number151542
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: