Provider Demographics
NPI:1043894215
Name:MUSONGWE, PRISCA T (NP)
Entity Type:Individual
Prefix:
First Name:PRISCA
Middle Name:T
Last Name:MUSONGWE
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 1:4340 SE SEATTLE SLEW DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4939
Mailing Address - Country:US
Mailing Address - Phone:816-805-3216
Mailing Address - Fax:
Practice Address - Street 1:4340 SE SEATTLE SLEW DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-4939
Practice Address - Country:US
Practice Address - Phone:816-805-3216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011040652363LF0000X
KS53-79351-072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily