Individual provider Active NPI

Nicole Raquel Fernando, FNP

  • Family Nurse Practitioner
  • Kansas City, KS
National Provider Identifier
1184503583
Registry record updated Aug 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
53-83946-061 Issued in KS
Practice address
721 N 31St St
Kansas City, KS 66102-3962
Phone
(913) 621-0074
NPI assigned
Aug 29, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 53-83946-061 KS Primary

Addresses

Primary practice location

721 N 31St St
Kansas City, KS 66102-3962

Mailing address

1444 Grand Blvd Apt 1104
Kansas City, MO 64106-2965
Phone (925) 522-1688

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260224002969 KS Practitioner - Nurse Practitioner 1153802541 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

PO Box
Suite 66
Stilwell, KS 66085

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
53-83946-061KSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy & Truth Healthcare Ministry, Inc Family CurrentSince Dec 31, 2025 Accepting new patients

Locations

721 N 31st St
Ste 101
Kansas City, KS 66102
Phone (913) 248-9965

721 N 31st St
Kansas City, KS 66102
Phone (913) 281-6457

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1756425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756425600000",
    "number": "1184503583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1444 GRAND BLVD APT 1104",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641062965",
            "telephone_number": "925-522-1688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 N 31ST ST",
            "city": "KANSAS CITY",
            "state": "KS",
            "postal_code": "661023962",
            "telephone_number": "913-621-0074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDO",
        "first_name": "NICOLE",
        "middle_name": "RAQUEL",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-29",
        "last_updated": "2025-08-29",
        "certification_date": "2025-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KS",
            "license": "53-83946-061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, KS

Sources for this page

Verify at the official NPI Registry.