Healthcare Provider Details

I. General information

NPI: 1396201562
Provider Name (Legal Business Name): ADRIAN HUTSON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 SW GRANDSTAND CIR
LEES SUMMIT MO
64081-3866
US

IV. Provider business mailing address

4600 COLLEGE BLVD
OVERLAND PARK KS
66211-1915
US

V. Phone/Fax

Practice location:
  • Phone: 913-215-5008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2019005029
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: