Healthcare Provider Details

I. General information

NPI: 1427019660
Provider Name (Legal Business Name): ANJA ILEEN ISMERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANJA ILEEN LOONEY FNP-C

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S PLATTE CLAY WAY STE A
KEARNEY MO
64060-8214
US

IV. Provider business mailing address

PO BOX 219672
KANSAS CITY MO
64121-9672
US

V. Phone/Fax

Practice location:
  • Phone: 816-628-4409
  • Fax: 816-628-5783
Mailing address:
  • Phone: 816-628-4409
  • Fax: 816-628-5783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14-96867-032
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number125822
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: