Healthcare Provider Details

I. General information

NPI: 1548736655
Provider Name (Legal Business Name): ALEXANDRA SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N BLUE JAY DR
LIBERTY MO
64068-1906
US

IV. Provider business mailing address

901 E 104TH ST
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 816-691-1424
  • Fax: 816-480-4511
Mailing address:
  • Phone: 816-436-7072
  • Fax: 816-436-2743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018035122
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: