Healthcare Provider Details

I. General information

NPI: 1215126826
Provider Name (Legal Business Name): CHERIAN GEORGE MALIPURATHU RN, MSN,FNP-BC, PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 E 59TH TER
KANSAS CITY MO
64110-3549
US

IV. Provider business mailing address

210 NE TUDOR RD
LEES SUMMIT MO
64086-5696
US

V. Phone/Fax

Practice location:
  • Phone: 816-523-6562
  • Fax:
Mailing address:
  • Phone: 888-256-3814
  • Fax: 888-256-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number401
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2001024018
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-75922-092
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2018012807
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number2004031658
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: