Healthcare Provider Details

I. General information

NPI: 1053868877
Provider Name (Legal Business Name): CHELSEA JUNE TUTERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA J LIGHT

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 WORNALL RD STE 50
KANSAS CITY MO
64111-3201
US

IV. Provider business mailing address

PO BOX 7411931
CHICAGO IL
60674-1931
US

V. Phone/Fax

Practice location:
  • Phone: 816-931-3312
  • Fax: 816-531-9862
Mailing address:
  • Phone: 816-931-3312
  • Fax: 816-531-9862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2016032098
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: