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General NPI Number Information
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NPI Number | 1508341207
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Entity Type | Individual
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Provider Name | KELLIE MARIE FRIES FNP
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Gender | Female
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Dates
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Enumeration Date | 09/27/2018
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Last Update Date | 09/27/2018
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Provider Practice Location Address
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Address Line | 1914 SWIFT AVE
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City | NORTH KANSAS CITY
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State | MO
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Zip | 64116-3447
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Country | US
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Telephone | 816-691-4156
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Fax |
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Provider Business Mailing Address
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Address Line | 1451 NW 38TH ST APT 110
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City | KANSAS CITY
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State | MO
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Zip | 64116-4554
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Country | US
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Telephone | 660-635-1392
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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 | 2018022898
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License Number State | MO
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