=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144032558
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. IAN MCCOMBS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2025
-----------------------------------------------------
Last Update Date | 05/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7450 KESSLER ST STE 202
-----------------------------------------------------
City | MERRIAM
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66204-2553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-632-9480
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6010 W 58TH ST
-----------------------------------------------------
City | MISSION
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66202-2632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-568-3924
-----------------------------------------------------
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 | 53-84185
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 2019021458
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------