Healthcare Provider Details

I. General information

NPI: 1366106163
Provider Name (Legal Business Name): HEATHER NICOLE TODD MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
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

400 SW LONGVIEW BLVD STE 200
LEES SUMMIT MO
64081-2116
US

V. Phone/Fax

Practice location:
  • Phone: 877-279-5960
  • Fax:
Mailing address:
  • Phone: 877-279-5960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number2021035400
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021035400
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: