Individual
DONNA WYLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3665
Mailing address
ATTN: PROVIDER ENROLLMENT DEPARTMENT, 2401 GILLHAM ROAD, KANSAS CITY, MO 64108-4619
(816) 701-5200
(816) 302-9939
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
125887
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
428123004
—
MO
Enumeration date
05/03/2006
Last updated
04/15/2021
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