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General NPI Number Information
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NPI Number | 1184503583
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Entity Type | Individual
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Provider Name | NICOLE RAQUEL FERNANDO FNP
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Gender | Female
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 721 N 31ST ST
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City | KANSAS CITY
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State | KS
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Zip | 66102-3962
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Country | US
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Telephone | 913-621-0074
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Fax |
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Provider Business Mailing Address
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Address Line | 1444 GRAND BLVD APT 1104
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City | KANSAS CITY
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State | MO
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Zip | 64106-2965
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Country | US
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Telephone | 925-522-1688
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 53-83946-061
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License Number State | KS
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