Healthcare Provider Details

I. General information

NPI: 1235962713
Provider Name (Legal Business Name): CRISTELE STEPHANIE TCHOKOUANI YAMDJEU PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW PRYOR RD
LEES SUMMIT MO
64081-1104
US

IV. Provider business mailing address

400 SW LONGVIEW BLVD STE 280
LEES SUMMIT MO
64081-2157
US

V. Phone/Fax

Practice location:
  • Phone: 816-347-2400
  • Fax:
Mailing address:
  • Phone: 877-384-3106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-83839-102
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024027497
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: