Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 2014032501 | MO |
NPI | 1184026858 |
---|---|
Provider Name | Ashley Celis |
First Address | Overland Park, KS 66215-2305 |
Second Address | Overland Park, KS 66215-2368 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2014 |
Last Update Date | 31/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2014032501 | LICENSE (01) | MO |