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NPI Code Detail

MEDICARE: DR. THAD RAHN WILSON FNP

MEDICARE: DR. THAD RAHN WILSON 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
1363LF0000XFamily Nurse Practitioner07434MO

General Provider Information

NPI Number : 1568634574
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THAD RAHN WILSON FNP
Provider Business Mailing Address
First Line : 12303 E SILVER LN
Second Line :
City : SUGAR CREEK
State : MO
Zip : 64054-1175
Country : US
Telephone Number : 816-461-7138
Fax Number :
Provider Business Practice Location Address
First Line : 3039 TROOST AVE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64109-1540
Country : US
Telephone Number : 816-329-5233
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2008
Last Update Date : 03/31/2008

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