Healthcare Provider Details

I. General information

NPI: 1962998328
Provider Name (Legal Business Name): MANDY WINKERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 ROCKHILL RD STE 302
KANSAS CITY MO
64131
US

IV. Provider business mailing address

11241 MONTGALL AVE APT 1001
KANSAS CITY MO
64137-3508
US

V. Phone/Fax

Practice location:
  • Phone: 816-541-3292
  • Fax: 816-541-3403
Mailing address:
  • Phone: 816-541-3292
  • Fax: 816-541-3403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberN000708954
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: