Healthcare Provider Details

I. General information

NPI: 1891448593
Provider Name (Legal Business Name): CHERIE R NYDEGGER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHERIE R GRAMSE

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 WORNALL RD STE 208
KANSAS CITY MO
64111-5964
US

IV. Provider business mailing address

1006 W 77TH TER
KANSAS CITY MO
64114-1759
US

V. Phone/Fax

Practice location:
  • Phone: 816-531-0552
  • Fax: 816-756-2503
Mailing address:
  • Phone: 816-289-2553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022003819
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: