Healthcare Provider Details

I. General information

NPI: 1912282864
Provider Name (Legal Business Name): ELIZABETH ANNE SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH CARPENTER

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 N CHURCH RD
KANSAS CITY MO
64158-1104
US

IV. Provider business mailing address

2609 GLENN HENDREN DR
LIBERTY MO
64068-3313
US

V. Phone/Fax

Practice location:
  • Phone: 816-407-2300
  • Fax: 816-407-2301
Mailing address:
  • Phone: 816-781-7730
  • Fax: 816-415-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2011032977
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: