Provider Demographics
NPI:1154019255
Name:WILSON, SUZANNA KAY (MSN, APRN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:SUZANNA
Middle Name:KAY
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSN, APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 GATES DR W
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-7507
Mailing Address - Country:US
Mailing Address - Phone:816-446-9897
Mailing Address - Fax:
Practice Address - Street 1:4370 W 109TH ST STE 350
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1370
Practice Address - Country:US
Practice Address - Phone:816-941-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023004370363L00000X
KS5382279081363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner