Healthcare Provider Details

I. General information

NPI: 1568304897
Provider Name (Legal Business Name): WOUND OSTOMY LEG & FOOT CARE CLINIC AND SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9808 E 66TH TER
RAYTOWN MO
64133-5850
US

IV. Provider business mailing address

2005 MARJORIE CIR
LEAVENWORTH KS
66048-2135
US

V. Phone/Fax

Practice location:
  • Phone: 913-547-3494
  • Fax: 833-970-2362
Mailing address:
  • Phone: 913-547-3494
  • Fax: 833-970-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: CANDICE LATRELLE LEWIS
Title or Position: FAMILY NURSE PRACTITIONER
Credential: DNP, FNP-C
Phone: 913-547-3494