Healthcare Provider Details

I. General information

NPI: 1780171462
Provider Name (Legal Business Name): ELIZABETH A BRAUN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 CHARLOTTE ST
KANSAS CITY MO
64108
US

IV. Provider business mailing address

2310 HOLMES ST STE 800
KANSAS CITY MO
64108-2602
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-7810
  • Fax: 816-404-1723
Mailing address:
  • Phone: 816-218-2500
  • Fax: 816-421-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2015021230
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2018021507
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: