Provider Demographics
NPI:1629610126
Name:SMITH, TERESA JACQULYN (APRN AGNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:JACQULYN
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN AGNP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:JACQULYN
Other - Last Name:FRAMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 SE BLUE PKWY
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-1041
Mailing Address - Country:US
Mailing Address - Phone:816-607-2950
Mailing Address - Fax:816-607-2990
Practice Address - Street 1:2000 SE BLUE PKWY
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-1041
Practice Address - Country:US
Practice Address - Phone:816-607-2950
Practice Address - Fax:816-607-2990
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOAG10190069363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology