Healthcare Provider Details

I. General information

NPI: 1619837689
Provider Name (Legal Business Name): BRIANNA FREDERICK APRN (AGNP-C)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3521 NE RALPH POWELL RD
LEES SUMMIT MO
64064-2337
US

IV. Provider business mailing address

14304 STEARNS ST
OVERLAND PARK KS
66221-7544
US

V. Phone/Fax

Practice location:
  • Phone: 816-533-4398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2025049901
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13144754042
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: