MEDICARE: HEATHER RENTON AGNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	AG03230012	MO
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	AG03230012	MO

General Provider Information

NPI Number	:	1225739089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER RENTON AGNP-C

Provider Business Mailing Address
First Line	:	11032 N MCKINLEY AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64157-1071
Country	:	US
Telephone Number	:	816-922-0641
Fax Number	:

Provider Business Practice Location Address
First Line	:	11032 N MCKINLEY AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64157-1071
Country	:	US
Telephone Number	:	816-922-0641
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2023
Last Update Date	:	03/16/2023

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Directions to “ HEATHER RENTON AGNP-C” Practice Location

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