Basic Information
Provider Information
NPI: 1396359923
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AYARS
FirstName: KELLI
MiddleName: NICOLE
NamePrefix:  
NameSuffix:  
Credential: APRN, NNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2401 GILLHAM RD
Address2:  
City: KANSAS CITY
State: MO
PostalCode: 641084619
CountryCode: US
TelephoneNumber: 8162343000
FaxNumber:  
Practice Location
Address1: 2401 GILLHAM RD
Address2:  
City: KANSAS CITY
State: MO
PostalCode: 641084619
CountryCode: US
TelephoneNumber: 8162343000
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/01/2020
LastUpdateDate: 09/01/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LN0005X2020027865MOY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care

No ID Information.


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