MEDICARE: MRS. ELIZABETH ANN HENRY NP-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	363LA2200X	Adult Health Nurse Practitioner	2011017381	MO
2	363LX0106X	Occupational Health Nurse Practitioner	53-75912-101	KS
3	363LF0000X	Family Nurse Practitioner	53-75912-101	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629362645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH ANN HENRY NP-C

Provider Business Mailing Address
First Line	:	12103 STATE ROUTE 7
Second Line	:
City	:	LAKE LOTAWANA
State	:	MO
Zip	:	64086-9165
Country	:	US
Telephone Number	:	816-853-3077
Fax Number	:	913-573-7001

Provider Business Practice Location Address
First Line	:	3201 FAIRFAX TRFY
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66115-1307
Country	:	US
Telephone Number	:	913-573-7053
Fax Number	:	913-573-7001

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

Provider Enumeration Date	:	06/07/2011
Last Update Date	:	08/25/2023

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