Basic Information
| Provider Information | |||||||||
| NPI: | 1316513260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLEAVER | ||||||||
| FirstName: | KYESIS | ||||||||
| MiddleName: | MONE' | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14701 GRAND SUMMIT BLVD APT 102 | ||||||||
| Address2: | |||||||||
| City: | GRANDVIEW | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640301931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165290485 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9100 PARK ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | LENEXA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662153353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137129680 | ||||||||
| FaxNumber: | 8773843106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2021 | ||||||||
| LastUpdateDate: | 02/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5380334062 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 2021019487 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 53-80334 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.