Provider Demographics
NPI:1619668845
Name:GRIFFITH, NATASHA (FNP-C)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26136 US HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:MO
Mailing Address - Zip Code:64446-9105
Mailing Address - Country:US
Mailing Address - Phone:660-686-2211
Mailing Address - Fax:660-686-2618
Practice Address - Street 1:12118 W 55TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-1305
Practice Address - Country:US
Practice Address - Phone:913-717-8064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-82196-062207Q00000X
MO2023024822363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine