Provider Demographics
NPI:1932508801
Name:BOTTOMS, RICHARD (FNP-C)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BOTTOMS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 N COSBY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2377
Mailing Address - Country:US
Mailing Address - Phone:816-643-4501
Mailing Address - Fax:
Practice Address - Street 1:6410 N COSBY AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2377
Practice Address - Country:US
Practice Address - Phone:816-643-4501
Practice Address - Fax:913-242-6921
Is Sole Proprietor?:No
Enumeration Date:2014-08-17
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021002077363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily