Healthcare Provider Details

I. General information

NPI: 1437673639
Provider Name (Legal Business Name): JAMIE GUDENKAUF FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2017
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 E 350
RAYTOWN MO
64133-6509
US

IV. Provider business mailing address

901 E 104TH ST
KANSAS CITY MO
64131
US

V. Phone/Fax

Practice location:
  • Phone: 816-251-5700
  • Fax: 816-251-5701
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number2004018112
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018000609
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: