Provider Demographics
NPI:1770108680
Name:COONS, CHERYL
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:COONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 NE 61ST CT
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-5311
Mailing Address - Country:US
Mailing Address - Phone:816-674-4922
Mailing Address - Fax:
Practice Address - Street 1:8629 BLUEJACKET ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1604
Practice Address - Country:US
Practice Address - Phone:913-677-3553
Practice Address - Fax:913-677-8328
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008029934163W00000X
KS79384363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse