MEDICARE: MRS. KELLY K SKINNER FNP - 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	363LF0000X	Family Nurse Practitioner	2006022291	MO

General Provider Information

NPI Number	:	1760711188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY K SKINNER FNP - C

Provider Business Mailing Address
First Line	:	19201 E VALLEY VIEW PKWY
Second Line	:	SUITE G
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6910
Country	:	US
Telephone Number	:	816-254-2552
Fax Number	:	816-833-0398

Provider Business Practice Location Address
First Line	:	19201 E VALLEY VIEW PKWY
Second Line	:	SUITE G
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6910
Country	:	US
Telephone Number	:	816-254-2552
Fax Number	:	816-833-0398

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

Provider Enumeration Date	:	12/14/2009
Last Update Date	:	01/26/2022

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