Provider Demographics
NPI:1780046250
Name:KOENEMANN, SARA NICOLE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:NICOLE
Last Name:KOENEMANN
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 1:8010 STATE LINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3711
Mailing Address - Country:US
Mailing Address - Phone:816-830-4285
Mailing Address - Fax:913-400-3631
Practice Address - Street 1:8010 STATE LINE RD STE 100
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3711
Practice Address - Country:US
Practice Address - Phone:816-830-4285
Practice Address - Fax:913-400-3631
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016007832363L00000X
KS53-77077-022363LF0000X
NE112929363LF0000X
MI4704380095363LF0000X
NM65631363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner