Healthcare Provider Details

I. General information

NPI: 1801601174
Provider Name (Legal Business Name): LISA NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 E LINWOOD BLVD
KANSAS CITY MO
64128-2226
US

IV. Provider business mailing address

7248 METCALF AVE
OVERLAND PARK KS
66204-1964
US

V. Phone/Fax

Practice location:
  • Phone: 816-922-2411
  • Fax:
Mailing address:
  • Phone: 913-638-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number2006020310
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: