Provider Demographics
NPI:1124397740
Name:SISAY, SERKALEM GETAHUN (RN, ANP-BC)
Entity Type:Individual
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First Name:SERKALEM
Middle Name:GETAHUN
Last Name:SISAY
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Gender:F
Credentials:RN, ANP-BC
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Mailing Address - Street 1:4330 WORNALL ROAD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-5939
Mailing Address - Country:US
Mailing Address - Phone:816-931-1883
Mailing Address - Fax:816-756-3645
Practice Address - Street 1:4330 WORNALL ROAD
Practice Address - Street 2:SUITE 2000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5939
Practice Address - Country:US
Practice Address - Phone:816-931-1883
Practice Address - Fax:816-756-3645
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2013-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2011035007363LA2200X
KS53-75224-122363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health