Provider Demographics
NPI:1124701123
Name:VITAL PRIMARY CARE
Entity type:Organization
Organization Name:VITAL PRIMARY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:913-802-2525
Mailing Address - Street 1:8273 N REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-1077
Mailing Address - Country:US
Mailing Address - Phone:816-588-7793
Mailing Address - Fax:
Practice Address - Street 1:8040 PARALLEL PKWY STE 112
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2072
Practice Address - Country:US
Practice Address - Phone:913-802-2525
Practice Address - Fax:913-802-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty