Healthcare Provider Details

I. General information

NPI: 1417231796
Provider Name (Legal Business Name): OYINKAN O PENNY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS OYINKAN OGUNTUASE

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6675 HOLMES RD SUITE 430
KANSAS CITY MO
64131-1150
US

IV. Provider business mailing address

6675 HOLMES RD SUITE 430
KANSAS CITY MO
64131-1150
US

V. Phone/Fax

Practice location:
  • Phone: 816-361-0055
  • Fax: 816-361-5775
Mailing address:
  • Phone: 816-361-0055
  • Fax: 816-361-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2011031627
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: