Healthcare Provider Details

I. General information

NPI: 1881231140
Provider Name (Legal Business Name): OLIVIA CHRISTINE POPLIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 CHARLOTTE ST
KANSAS CITY MO
64108-2727
US

IV. Provider business mailing address

8210 KENWOOD AVE
KANSAS CITY MO
64131-2213
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-0072
  • Fax: 816-404-9902
Mailing address:
  • Phone: 816-591-9918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2019043761
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: