Healthcare Provider Details

I. General information

NPI: 1114184892
Provider Name (Legal Business Name): EDWARD FRANKLIN DULLENTY RN BSNMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SE 2ND STREET SUITE 100
LEES SUMMIT MO
64063
US

IV. Provider business mailing address

3719 JEFFERSON STREET
KANSAS CITY MO
64111
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-6193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number085700
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: