Provider Demographics
NPI:1568808061
Name:SWAGGERTY, DEANNA MICHELLE (MSN-APRN)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MICHELLE
Last Name:SWAGGERTY
Suffix:
Gender:F
Credentials:MSN-APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8765 N AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-2540
Mailing Address - Country:US
Mailing Address - Phone:913-297-7472
Mailing Address - Fax:
Practice Address - Street 1:8765 N AMBASSADOR DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-2540
Practice Address - Country:US
Practice Address - Phone:913-297-7472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-12
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012041205363LF0000X
KS53-75768-022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420005275Medicaid