Provider Demographics
NPI:1609407477
Name:GOMES, VIOLET A (DNP, APRN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:VIOLET
Middle Name:A
Last Name:GOMES
Suffix:
Gender:F
Credentials:DNP, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 EISENHOWER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5161
Mailing Address - Country:US
Mailing Address - Phone:913-250-2000
Mailing Address - Fax:913-250-2039
Practice Address - Street 1:500 EISENHOWER RD STE 101
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5161
Practice Address - Country:US
Practice Address - Phone:913-250-2000
Practice Address - Fax:913-250-2039
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS108956163WP2201X
KS79580363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS108956OtherKS STARE BOARD OF NURSING
KS79580OtherAPRN LICENSE