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General NPI Number Information
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NPI Number | 1780420083
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Entity Type | Individual
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Provider Name | RYANN BLACKA APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/05/2024
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 4801 E LINWOOD BLVD
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City | KANSAS CITY
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State | MO
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Zip | 64128-2226
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Country | US
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Telephone | 816-861-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 1248 SE WARREN DR
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City | LEES SUMMIT
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State | MO
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Zip | 64081-2144
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Country | US
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Telephone | 267-625-7397
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2024007929
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2024007929
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License Number State | MO
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