Healthcare Provider Details

I. General information

NPI: 1497258586
Provider Name (Legal Business Name): ROBERT JAMES PHELPS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 E MEYER BLVD STE 411
KANSAS CITY MO
64132-1152
US

IV. Provider business mailing address

2330 E MEYER BLVD STE 411
KANSAS CITY MO
64132-1152
US

V. Phone/Fax

Practice location:
  • Phone: 816-363-2500
  • Fax: 816-363-8741
Mailing address:
  • Phone: 816-363-2500
  • Fax: 816-363-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2018004209
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: