Healthcare Provider Details

I. General information

NPI: 1982297305
Provider Name (Legal Business Name): ANASTASIA MARIE KLOCKMAN ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 E MEYER BLVD
KANSAS CITY MO
64132-1136
US

IV. Provider business mailing address

6650 W 110TH ST STE 220A
OVERLAND PARK KS
66211-1501
US

V. Phone/Fax

Practice location:
  • Phone: 816-276-4000
  • Fax:
Mailing address:
  • Phone: 913-549-3884
  • Fax: 913-273-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2021004832
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: