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General NPI Number Information
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NPI Number | 1437785672
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Entity Type | Individual
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Provider Name | KEITH E TRAMMELL FNP
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Gender | Male
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 2340 E MEYER BLVD, BLDG 2 SUITE 392
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City | KANSAS CITY
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State | MO
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Zip | 64132-6413
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Country | US
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Telephone | 816-444-7977
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Fax |
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Provider Business Mailing Address
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Address Line | 901 MCCLINTOCK DR STE 202
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City | BURR RIDGE
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State | IL
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Zip | 60527-0872
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Country | US
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Telephone | 630-655-6748
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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 | 2020009541
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License Number State | MO
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