Provider Demographics
NPI:1902228679
Name:POWELL, MARY (ARNP, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:ARNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11217 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:64131-4731
Mailing Address - Country:US
Mailing Address - Phone:913-332-7401
Mailing Address - Fax:913-322-7410
Practice Address - Street 1:11217 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1399
Practice Address - Country:US
Practice Address - Phone:913-322-7401
Practice Address - Fax:913-322-7410
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014000954363LF0000X
KS53-76412-031363LF0000X
KS76413363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily