Healthcare Provider Details

I. General information

NPI: 1184016529
Provider Name (Legal Business Name): CHRISTOPHER PELTON FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 01/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 NW MURRAY RD
LEES SUMMIT MO
64081-1428
US

IV. Provider business mailing address

12140 NALL AVE STE 100
OVERLAND PARK KS
66209-2504
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-4400
  • Fax:
Mailing address:
  • Phone: 816-943-0706
  • Fax: 913-451-1754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015001951
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76641-082
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: