MEDICARE: RACHEL ANN CORL APRN

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	163W00000X	Registered Nurse	14-139501-102	KS
2	163W00000X	Registered Nurse	2009017349	MO
3	363LF0000X	Family Nurse Practitioner	53-80930-102	KS
4	363LF0000X	Family Nurse Practitioner	2022003806	MO

General Provider Information

NPI Number	:	1306591557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL ANN CORL APRN

Provider Business Mailing Address
First Line	:	8404 MERCIER ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-2130
Country	:	US
Telephone Number	:	417-274-1090
Fax Number	:

Provider Business Practice Location Address
First Line	:	8404 MERCIER ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-2130
Country	:	US
Telephone Number	:	417-274-1090
Fax Number	:

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

Provider Enumeration Date	:	02/16/2022
Last Update Date	:	02/16/2022

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