MEDICARE: KEITH E TRAMMELL FNP

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	363LF0000X	Family Nurse Practitioner	2020009541	MO

General Provider Information

NPI Number	:	1437785672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH E TRAMMELL FNP

Provider Business Mailing Address
First Line	:	901 MCCLINTOCK DR STE 202
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-0872
Country	:	US
Telephone Number	:	630-655-6748
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 E MEYER BLVD, BLDG 2
Second Line	:	SUITE 392
City	:	KANSAS CITY
State	:	MO
Zip	:	64132-6413
Country	:	US
Telephone Number	:	816-444-7977
Fax Number	:

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

Provider Enumeration Date	:	03/19/2020
Last Update Date	:	06/22/2020

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