Healthcare Provider Details

I. General information

NPI: 1861248395
Provider Name (Legal Business Name): BREANNA M HANCOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5506 CORPORATE DR STE 1600
SAINT JOSEPH MO
64507-7765
US

IV. Provider business mailing address

1100 NW SOUTH OUTER RD STE 200
BLUE SPRINGS MO
64015-3069
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-7848
  • Fax: 816-271-7751
Mailing address:
  • Phone: 888-256-3814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2024010424
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: