Healthcare Provider Details

I. General information

NPI: 1841617909
Provider Name (Legal Business Name): TITANIA RAE WATKINS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 STATE LINE RD # 300
KANSAS CITY MO
64114-3232
US

IV. Provider business mailing address

9001 STATE LINE RD # 300
KANSAS CITY MO
64114-3232
US

V. Phone/Fax

Practice location:
  • Phone: 816-363-2600
  • Fax: 816-523-0068
Mailing address:
  • Phone: 816-363-2600
  • Fax: 816-523-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2014009619
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number76300
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: