Provider Demographics
NPI:1164882544
Name:KURTZ, EBONY N (APRN)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:N
Last Name:KURTZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:EBONY
Other - Middle Name:N
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-701-5212
Mailing Address - Fax:816-302-9939
Practice Address - Street 1:3101 BROADWAY BLVD
Practice Address - Street 2:ADOLESCENT MEDICINE
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111
Practice Address - Country:US
Practice Address - Phone:816-960-3050
Practice Address - Fax:816-960-3038
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016001982363LP0200X
KS77121363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics