Healthcare Provider Details

I. General information

NPI: 1386198406
Provider Name (Legal Business Name): SAMUEL W MUCHIRI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 SW GRANDSTAND CIR
LEES SUMMIT MO
64081-3866
US

IV. Provider business mailing address

PO BOX 875743
KANSAS CITY MO
64187-5743
US

V. Phone/Fax

Practice location:
  • Phone: 913-215-5008
  • Fax: 816-447-3960
Mailing address:
  • Phone: 913-215-5008
  • Fax: 816-447-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2016016593
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2012004415
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: