Healthcare Provider Details

I. General information

NPI: 1194278481
Provider Name (Legal Business Name): JULIE A. RACZKOWSKI F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE ANN HALTER

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 10/24/2021
Certification Date: 10/24/2021
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 TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016028019
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: