Healthcare Provider Details

I. General information

NPI: 1912573627
Provider Name (Legal Business Name): NICHOLAS JAMES SMITH FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6675 HOLMES RD
KANSAS CITY MO
64131-1150
US

IV. Provider business mailing address

17923 S FRANCY RD
PLEASANT HILL MO
64080-9287
US

V. Phone/Fax

Practice location:
  • Phone: 816-808-7404
  • Fax:
Mailing address:
  • Phone: 816-808-7404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2017038774
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2021043558
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: