Healthcare Provider Details

I. General information

NPI: 1144828716
Provider Name (Legal Business Name): SAMANTHA KAYE IRWIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 E MEYER BLVD
KANSAS CITY MO
64132-1132
US

IV. Provider business mailing address

2330 E MEYER BLVD
KANSAS CITY MO
64132-1132
US

V. Phone/Fax

Practice location:
  • Phone: 816-756-2651
  • Fax:
Mailing address:
  • Phone: 816-756-2651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number2009015723
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF12201042
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: