Healthcare Provider Details

I. General information

NPI: 1609235506
Provider Name (Legal Business Name): RENAE BRINES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 WORNALL ROAD
KANSAS CITY MO
64111
US

IV. Provider business mailing address

PO BOX 504407
ST LOUIS MO
63150
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-3679
  • Fax:
Mailing address:
  • Phone: 816-502-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number2016001338
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: