Healthcare Provider Details

I. General information

NPI: 1114596830
Provider Name (Legal Business Name): ABIGAIL MARIE ENSZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 MADISON AVE STE 10
KANSAS CITY MO
64111-3509
US

IV. Provider business mailing address

8611 N ARCOLA AVE
KANSAS CITY MO
64153-2869
US

V. Phone/Fax

Practice location:
  • Phone: 816-533-3863
  • Fax:
Mailing address:
  • Phone: 785-424-0758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2025046939
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: