Provider Demographics
NPI:1447859921
Name:NORRIS, DENETRA (RN)
Entity type:Individual
Prefix:
First Name:DENETRA
Middle Name:
Last Name:NORRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 PENNSYLVANIA AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3041
Mailing Address - Country:US
Mailing Address - Phone:816-287-0311
Mailing Address - Fax:
Practice Address - Street 1:8508 EVERETT ST
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-3133
Practice Address - Country:US
Practice Address - Phone:816-287-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170370605163WC0400X, 163WC1500X, 163WG0000X, 163WH0200X, 163WN1003X, 163WP0200X, 163WP0807X, 163WP0808X, 163WP0809X, 163WR0400X, 163WS0200X, 163WW0000X, 163WX1500X
MO2017037065163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2017037065OtherMISSOURI BOARD OF NURSING