Healthcare Provider Details

I. General information

NPI: 1639109440
Provider Name (Legal Business Name): LINDA GRACE FREY MSN, FNP-BC, RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 02/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18100 E 215TH ST
PECULIAR MO
64078-9200
US

IV. Provider business mailing address

18100 E 215TH ST
PECULIAR MO
64078-9200
US

V. Phone/Fax

Practice location:
  • Phone: 816-304-7107
  • Fax: 816-380-6529
Mailing address:
  • Phone: 816-304-7107
  • Fax: 816-380-6529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number146414
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number14-97759-112
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number46307
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: