Provider Demographics
NPI:1679580260
Name:SCHMIDT, DALE LYNN (ARNP)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:LYNN
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9411 N OAK TRFY
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2233
Mailing Address - Country:US
Mailing Address - Phone:816-436-7072
Mailing Address - Fax:816-436-2743
Practice Address - Street 1:2790 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3276
Practice Address - Country:US
Practice Address - Phone:816-691-5232
Practice Address - Fax:816-346-7038
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44323363LA2200X
MO2012022796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100254190BMedicaid
160803Medicare ID - Type Unspecified