Healthcare Provider Details

I. General information

NPI: 1326421272
Provider Name (Legal Business Name): KRISTEN THATCHER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN L GILMORE

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8880 NE 82ND TER
KANSAS CITY MO
64158-1313
US

IV. Provider business mailing address

8880 NE 82ND TER
KANSAS CITY MO
64158-1313
US

V. Phone/Fax

Practice location:
  • Phone: 816-437-8122
  • Fax: 816-407-9609
Mailing address:
  • Phone: 816-437-8122
  • Fax: 816-407-9609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA140020
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015008347
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2002017187
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: