Healthcare Provider Details

I. General information

NPI: 1912285669
Provider Name (Legal Business Name): DAWN L CHILDS APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN L GLADSON

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SW 3RD ST
LEES SUMMIT MO
64063-2212
US

IV. Provider business mailing address

8550 MARSHALL DR STE 220
LENEXA KS
66214-1505
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-3799
  • Fax: 913-495-3727
Mailing address:
  • Phone: 816-524-3799
  • Fax: 913-495-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2011019332
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: