Healthcare Provider Details

I. General information

NPI: 1013766211
Provider Name (Legal Business Name): KRISHNA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2024
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4908 NW MONTEBELLA DR
RIVERSIDE MO
64150-7823
US

IV. Provider business mailing address

4908 NW MONTEBELLA DR
RIVERSIDE MO
64150-7823
US

V. Phone/Fax

Practice location:
  • Phone: 816-888-0769
  • Fax:
Mailing address:
  • Phone: 816-888-0769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2016019529
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04240592
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024021762
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: