Healthcare Provider Details

I. General information

NPI: 1366562001
Provider Name (Legal Business Name): KIMBERLY JOYCE BYWATERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 E 117TH ST
KANSAS CITY MO
64134-3701
US

IV. Provider business mailing address

6801 E 117TH ST
KANSAS CITY MO
64134-3701
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-4285
  • Fax: 816-554-5550
Mailing address:
  • Phone: 816-554-4285
  • Fax: 816-554-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number13-60603-022
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: