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NPI Code Detail

MEDICARE: KELLY R FRITZ PNP

MEDICARE: KELLY R FRITZ PNP
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
1363LP0200XPediatric Nurse Practitioner089300MO

General Provider Information

NPI Number : 1679566913
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY R FRITZ PNP
Provider Business Mailing Address
First Line : 1425 NW BLUE PKWY
Second Line :
City : LEES SUMMIT
State : MO
Zip : 64086-5705
Country : US
Telephone Number : 816-524-3223
Fax Number : 816-525-2697
Provider Business Practice Location Address
First Line : 1600 NW SOUTH OUTER RD
Second Line :
City : BLUE SPRINGS
State : MO
Zip : 64015-2963
Country : US
Telephone Number : 816-524-3223
Fax Number : 816-525-2697
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2005
Last Update Date : 06/13/2011

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