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General NPI Number Information
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NPI Number | 1922358084
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Entity Type | Organization
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Legal Business Name | TRINITY PRIMARY CARE CLINIC
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 520 W 103RD ST STE 172
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City | KANSAS CITY
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State | MO
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Zip | 64114-4503
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Country | US
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Telephone | 913-961-1478
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Fax |
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Provider Business Mailing Address
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Address Line | 520 W 103RD ST STE 172
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City | KANSAS CITY
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State | MO
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Zip | 64114-4503
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | APRN
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Name | MRS. TIWANA ALLEN
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Credential | MSN
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Telephone | 913-961-1478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 155480
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License Number State | MO
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