Provider Demographics
NPI:1568758829
Name:EGBEDEJU, ANTHONIA O (FNP)
Entity Type:Individual
Prefix:
First Name:ANTHONIA
Middle Name:O
Last Name:EGBEDEJU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7527 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-2815
Mailing Address - Country:US
Mailing Address - Phone:913-335-6986
Mailing Address - Fax:855-446-7151
Practice Address - Street 1:7527 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2815
Practice Address - Country:US
Practice Address - Phone:913-335-6986
Practice Address - Fax:855-446-7151
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN149732163W00000X
TNAPN154784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS53-78721-121OtherSTATE LICENSE
MO2019006675OtherSTATE LICENSE
TNAPN15784OtherSTATE LICENSE
MOME5679420OtherDEA
TNAPN15784OtherSTATE LICENSE