=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790507259
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KANSAS CITY MEDICAL EXAMS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2024
-----------------------------------------------------
Last Update Date | 10/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410C SE 3RD ST
-----------------------------------------------------
City | LEES SUMMIT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64063-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-773-6900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30106 E 135TH ST
-----------------------------------------------------
City | LEES SUMMIT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64086-9400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-773-6900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | ANNA NIXON
-----------------------------------------------------
Credential | NP-C
-----------------------------------------------------
Telephone | 417-773-6900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------