Individual
CRYSTAL SHEETS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7900 LEES SUMMIT RD, KANSAS CITY, MO 64139-1236
(816) 404-7500
(816) 404-7514
Mailing address
1221 SE 12TH ST, LEES SUMMIT, MO 64081-2905
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2018004924
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420052915
—
MO
Enumeration date
02/12/2018
Last updated
12/03/2020
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