Provider Demographics
NPI:1386457695
Name:RATHJEN, PAYTON ELIZABETH
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:ELIZABETH
Last Name:RATHJEN
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 1:5050 MAIN ST APT 715
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2903
Mailing Address - Country:US
Mailing Address - Phone:816-868-3133
Mailing Address - Fax:
Practice Address - Street 1:2330 E MEYER BLVD STE 509
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1177
Practice Address - Country:US
Practice Address - Phone:816-868-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025002312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily