Provider Demographics
NPI:1689327066
Name:ITKONEN, RACHEL LYN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYN
Last Name:ITKONEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 NW HWY 7 SUITE A
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-3332
Mailing Address - Country:US
Mailing Address - Phone:816-229-8187
Mailing Address - Fax:
Practice Address - Street 1:725 NW HWY 7 SUITE A
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-6401
Practice Address - Country:US
Practice Address - Phone:816-229-8187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022002985363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily