Individual
KAITLIN REBECCA LIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
5555 W 58TH ST, MISSION, KS 66202-1999
(913) 432-2080
Mailing address
5555 W 58TH ST, MISSION, KS 66202-2722
(913) 432-2080
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
06190514
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1952961849
NPI
—
Enumeration date
06/13/2019
Last updated
08/11/2020
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