Healthcare Provider Details

I. General information

NPI: 1164236816
Provider Name (Legal Business Name): DEVIN DAENAR SMITH FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 DR MARTIN LUTHER KING JR BLVD
KANSAS CITY MO
64130-2807
US

IV. Provider business mailing address

3801 DR MARTIN LUTHER KING JR BLVD
KANSAS CITY MO
64130-2807
US

V. Phone/Fax

Practice location:
  • Phone: 816-923-5800
  • Fax: 816-923-3801
Mailing address:
  • Phone: 816-923-5800
  • Fax: 816-923-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-83805-091
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: