Provider Demographics
NPI:1417767799
Name:KOELLING, THERESA ANNE (RN, BSN, MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANNE
Last Name:KOELLING
Suffix:
Gender:F
Credentials:RN, BSN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8544 N AVA AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1886
Mailing Address - Country:US
Mailing Address - Phone:314-779-7056
Mailing Address - Fax:
Practice Address - Street 1:501 NW BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2732
Practice Address - Country:US
Practice Address - Phone:816-413-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-83901-111363L00000X
MO2024015292363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner