Provider Demographics
NPI:1427019660
Name:ISMERT, ANJA ILEEN
Entity Type:Individual
Prefix:
First Name:ANJA
Middle Name:ILEEN
Last Name:ISMERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANJA
Other - Middle Name:ILEEN
Other - Last Name:LOONEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 219672
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9672
Mailing Address - Country:US
Mailing Address - Phone:816-628-4409
Mailing Address - Fax:816-628-5783
Practice Address - Street 1:305 S PLATTE CLAY WAY
Practice Address - Street 2:STE A
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-8214
Practice Address - Country:US
Practice Address - Phone:816-628-4409
Practice Address - Fax:816-628-5783
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-96867-032363LF0000X
MO125822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST59E325Medicare ID - Type Unspecified
MOQ61095Medicare UPIN