Provider Demographics
NPI:1215357413
Name:BURNS-SMITH, FELICIA C
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:C
Last Name:BURNS-SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 W 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66103-2107
Mailing Address - Country:US
Mailing Address - Phone:913-956-5620
Mailing Address - Fax:913-362-0431
Practice Address - Street 1:2205 W 36TH AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-2107
Practice Address - Country:US
Practice Address - Phone:913-956-5620
Practice Address - Fax:913-362-0431
Is Sole Proprietor?:No
Enumeration Date:2014-04-27
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-103842-122163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098080COtherSED WAIVER
KS100098080AMedicaid