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General NPI Number Information
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NPI Number | 1568304897
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Entity Type | Organization
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Legal Business Name | WOUND OSTOMY LEG & FOOT CARE CLINIC AND SPA
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Dates
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Enumeration Date | 04/07/2026
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Last Update Date | 04/07/2026
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Provider Practice Location Address
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Address Line | 9808 E 66TH TER
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City | RAYTOWN
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State | MO
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Zip | 64133-5850
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Country | US
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Telephone | 913-547-3494
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Fax | 833-970-2362
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Provider Business Mailing Address
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Address Line | 2005 MARJORIE CIR
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City | LEAVENWORTH
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State | KS
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Zip | 66048-2135
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Country | US
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Telephone | 913-547-3494
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Fax | 833-970-2362
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | CANDICE LATRELLE LEWIS
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Credential | DNP, FNP-C
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Telephone | 913-547-3494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WX1500X
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Taxonomy Name | Ostomy Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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