Healthcare Provider Details

I. General information

NPI: 1891974135
Provider Name (Legal Business Name): UCHENNA ANTONIA ECHENDU FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 08/21/2021
Certification Date: 08/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 W FOXWOOD DR
RAYMORE MO
64083-8301
US

IV. Provider business mailing address

9924 HARDESTY AVE
KANSAS CITY MO
64137-1338
US

V. Phone/Fax

Practice location:
  • Phone: 816-318-8022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2006021368
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number14-122562-092
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2333766092
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-78936-092
License Number StateKS
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020010069
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: