Basic Information
| Provider Information | |||||||||
| NPI: | 1801847595 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEARING | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5419 PAWNEE LN | ||||||||
| Address2: | |||||||||
| City: | FAIRWAY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662052738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164826378 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5701 W 119TH ST | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662093721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133456960 | ||||||||
| FaxNumber: | 9133456966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2005029304 | MO | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 0428286 | KS | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 722636 | 01 | MO | HEALTHLINK | OTHER | 207546300 | 05 | MO | MEDICAID |