Healthcare Provider Details

I. General information

NPI: 1689923138
Provider Name (Legal Business Name): TRACY J EASON RN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM ROAD
KANSAS CITY MO
64108
US

IV. Provider business mailing address

7513 NORTH GRANBY
KANSAS CITY MO
64151
US

V. Phone/Fax

Practice location:
  • Phone: 816-234-3300
  • Fax:
Mailing address:
  • Phone: 816-214-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number144017
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: