Healthcare Provider Details

I. General information

NPI: 1851821987
Provider Name (Legal Business Name): TAMMY RAYANN MINSHALL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SW LONGVIEW BLVD STE 200
LEES SUMMIT MO
64081-2116
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: 913-297-1202
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017020879
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: