Provider Demographics
NPI:1255965000
Name:WIEST, SEAN ALAN (PMHNP)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:ALAN
Last Name:WIEST
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 COLUMBINE CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2290
Mailing Address - Country:US
Mailing Address - Phone:816-673-6503
Mailing Address - Fax:
Practice Address - Street 1:1106 E 30TH ST STE B
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64109-1507
Practice Address - Country:US
Practice Address - Phone:816-601-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020016222363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health