Healthcare Provider Details

I. General information

NPI: 1407180771
Provider Name (Legal Business Name): DOLLY CHERIAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W. 11TH ST. STE. 1215
KANSAS CITY MO
64108-1813
US

IV. Provider business mailing address

1707 E 59TH TER
KANSAS CITY MO
64110-3549
US

V. Phone/Fax

Practice location:
  • Phone: 816-822-0050
  • Fax:
Mailing address:
  • Phone: 816-522-9292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2005003493
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: