=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003480203
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES O'HARA FNP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2021
-----------------------------------------------------
Last Update Date | 10/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6807 W 121ST ST
-----------------------------------------------------
City | LEAWOOD
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66209-2005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-356-1007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11124 W 109TH TER
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66210-1202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-518-0872
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 80834
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 71011131A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------