Healthcare Provider Details

I. General information

NPI: 1982764718
Provider Name (Legal Business Name): DANA L KAPP PNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N 36TH ST STE B
SAINT JOSEPH MO
64506-2954
US

IV. Provider business mailing address

805 N 36TH ST STE B
SAINT JOSEPH MO
64506-2954
US

V. Phone/Fax

Practice location:
  • Phone: 816-396-6026
  • Fax: 816-398-6896
Mailing address:
  • Phone: 816-396-6026
  • Fax: 816-398-6896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number132114
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: