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General NPI Number Information
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NPI Number | 1255965000
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Entity Type | Individual
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Provider Name | SEAN ALAN WIEST PMHNP
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Gender | Male
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 06/19/2020
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Provider Practice Location Address
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Address Line | 1106 E 30TH ST STE B
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City | KANSAS CITY
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State | MO
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Zip | 64109-1507
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Country | US
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Telephone | 816-601-2375
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Fax |
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Provider Business Mailing Address
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Address Line | 1576 COLUMBINE CT
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City | LIBERTY
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State | MO
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Zip | 64068-2290
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Country | US
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Telephone | 816-673-6503
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2020016222
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License Number State | MO
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