Healthcare Provider Details

I. General information

NPI: 1114864071
Provider Name (Legal Business Name): AUDREY SUBASIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUDREY KUMP

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 WORNALL RD
KANSAS CITY MO
64111-3220
US

IV. Provider business mailing address

PO BOX 7411901
CHICAGO IL
60674-1901
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-3679
  • Fax: 816-932-9089
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2026024566
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: