Provider Demographics
NPI:1275579682
Name:VILLENA, ANNETTE CHRISTINE (APRN-C)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:CHRISTINE
Last Name:VILLENA
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 CLAY EDWARDS DR STE 520
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3274
Mailing Address - Country:US
Mailing Address - Phone:816-221-6750
Mailing Address - Fax:816-221-2335
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 520
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3274
Practice Address - Country:US
Practice Address - Phone:816-221-6750
Practice Address - Fax:816-221-2335
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-45357363L00000X
KS45357363LP2300X
MO2020016186363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200612400BMedicaid
KS068002211OtherMEDICARE PTAN
KS068002211OtherMEDICARE PTAN
KS160960Medicare ID - Type UnspecifiedWASH CO PROF