Healthcare Provider Details

I. General information

NPI: 1497263024
Provider Name (Legal Business Name): ALICIA O CAVALIERI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N WEBB ST
WEBB CITY MO
64870-1916
US

IV. Provider business mailing address

4061 INDIAN CREEK PKWY
OVERLAND PARK KS
66207-4030
US

V. Phone/Fax

Practice location:
  • Phone: 417-673-0366
  • Fax: 417-673-0093
Mailing address:
  • Phone: 913-323-8885
  • Fax: 913-323-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017044571
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number78800
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: