Healthcare Provider Details

I. General information

NPI: 1942825328
Provider Name (Legal Business Name): ALEXANDRIA NICOLE DENNISON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SE BLUE PKWY
LEES SUMMIT MO
64063-1007
US

IV. Provider business mailing address

12140 NALL AVE STE 300
OVERLAND PARK KS
66209-2503
US

V. Phone/Fax

Practice location:
  • Phone: 816-282-5000
  • Fax: 913-498-6708
Mailing address:
  • Phone: 913-498-7004
  • Fax: 913-498-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9410465
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: