Healthcare Provider Details

I. General information

NPI: 1942924337
Provider Name (Legal Business Name): DAWN MICHELLE RHODES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 JESSICA LN
RAYTOWN MO
64138-2639
US

IV. Provider business mailing address

981 WYCKWOOD DR
LIBERTY MO
64068-3320
US

V. Phone/Fax

Practice location:
  • Phone: 816-203-8513
  • Fax: 816-886-7632
Mailing address:
  • Phone: 417-434-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022036526
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: