Healthcare Provider Details

I. General information

NPI: 1740583897
Provider Name (Legal Business Name): INESSA IZYEVNA SERGEYEVA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 NE RALPH POWELL RD STE C
LEES SUMMIT MO
64064-2316
US

IV. Provider business mailing address

5501 NW 62ND TER STE 100
KANSAS CITY MO
64151-2412
US

V. Phone/Fax

Practice location:
  • Phone: 816-285-5053
  • Fax: 816-842-1974
Mailing address:
  • Phone: 816-842-4440
  • Fax: 816-842-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2010031309
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-75284-122
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2010031309
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11018451
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: