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Individual

DAXTEN PRUTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NURSE PRACTITIONER

Contact information

Practice address
4251 NORTHERN AVE, KANSAS CITY, MO 64133-1593
(181) 686-1470
Mailing address
4801 E LINWOOD BLVD, KANSAS CITY, MO 64128-2226
(816) 446-4082

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0121556
OK
363LF0000X
Family Nurse Practitioner
Primary
53-79163-032
KS

Other

Enumeration date
08/24/2016
Last updated
11/19/2020
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