Provider Demographics
NPI:1578190062
Name:KUME, IMMACULATE NKWAYE (FNP)
Entity Type:Individual
Prefix:
First Name:IMMACULATE
Middle Name:NKWAYE
Last Name:KUME
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 1:8219 E 85TH TER
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-3020
Mailing Address - Country:US
Mailing Address - Phone:816-204-1334
Mailing Address - Fax:
Practice Address - Street 1:8219 E 85TH TER
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-3020
Practice Address - Country:US
Practice Address - Phone:816-204-1334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO23541795163WG0600X
KS80845363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0600XNursing Service ProvidersRegistered NurseGerontology