Healthcare Provider Details

I. General information

NPI: 1326694191
Provider Name (Legal Business Name): KELCI NOEL COUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 CLAY EDWARDS DR STE 600
NORTH KANSAS CITY MO
64116-3274
US

IV. Provider business mailing address

2790 CLAY EDWARDS DR STE 600
NORTH KANSAS CITY MO
64116-3274
US

V. Phone/Fax

Practice location:
  • Phone: 816-691-5048
  • Fax: 816-346-7039
Mailing address:
  • Phone: 816-691-5048
  • Fax: 816-346-7039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2013002874
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5379108011
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019040547
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: