Provider Demographics
NPI:1982764718
Name:KAPP, DANA L (PNP-BC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:L
Last Name:KAPP
Suffix:
Gender:F
Credentials:PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 N 36TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2954
Mailing Address - Country:US
Mailing Address - Phone:816-396-6026
Mailing Address - Fax:816-398-6896
Practice Address - Street 1:805 N 36TH ST STE B
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2954
Practice Address - Country:US
Practice Address - Phone:816-396-6026
Practice Address - Fax:816-398-6896
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO132114363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100371310AMedicaid
MO424750701Medicaid