Healthcare Provider Details

I. General information

NPI: 1750484242
Provider Name (Legal Business Name): DANIELLE LYNN SKIRCHAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/28/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5904 E BANNISTER RD
KANSAS CITY MO
64134-1141
US

IV. Provider business mailing address

1555 NE RICE RD
LEES SUMMIT MO
64086-5849
US

V. Phone/Fax

Practice location:
  • Phone: 816-966-0903
  • Fax: 816-761-3433
Mailing address:
  • Phone: 816-966-0903
  • Fax: 816-761-3433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31729
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2015025549
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: