Provider Demographics
NPI:1003355322
Name:WERTZ, RANDYN (NP)
Entity Type:Individual
Prefix:
First Name:RANDYN
Middle Name:
Last Name:WERTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 WORNALL RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1344
Mailing Address - Country:US
Mailing Address - Phone:816-523-9355
Mailing Address - Fax:816-523-9358
Practice Address - Street 1:7130 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1344
Practice Address - Country:US
Practice Address - Phone:816-523-9355
Practice Address - Fax:816-523-9358
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017004799363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner