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General NPI Number Information
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NPI Number | 1265574461
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Entity Type | Individual
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Provider Name | VANPRASEUTH FONGNALY M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 4401 WORNALL RD
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City | KANSAS CITY
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State | MO
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Zip | 64111
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Country | US
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Telephone | 816-932-3679
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Fax | 816-932-9089
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Provider Business Mailing Address
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Address Line | 901 E 104TH ST MAILSTOP 400S
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City | KANSAS CITY
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State | MO
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Zip | 64131
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Country | US
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Telephone | 816-502-8782
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 2014025191
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | D0068983
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | CDRH.0068942
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 3724
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License Number State | WI
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