Provider Demographics
NPI:1235724659
Name:KACIREK, ANNA RACHELLE (APRN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:RACHELLE
Last Name:KACIREK
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4400 BROADWAY BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3342
Mailing Address - Country:US
Mailing Address - Phone:816-561-8100
Mailing Address - Fax:816-561-8154
Practice Address - Street 1:4400 BROADWAY BLVD STE 206
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3342
Practice Address - Country:US
Practice Address - Phone:816-561-8100
Practice Address - Fax:816-561-8154
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021008238363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty