Healthcare Provider Details

I. General information

NPI: 1023988342
Provider Name (Legal Business Name): KEVIN WANJIKU WACHIRA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5830 NW BARRY RD
KANSAS CITY MO
64154-2778
US

IV. Provider business mailing address

7612 NW MILREY DR
KANSAS CITY MO
64152-2262
US

V. Phone/Fax

Practice location:
  • Phone: 816-880-6560
  • Fax:
Mailing address:
  • Phone: 417-317-6062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number2025048639
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: