Quality Wound Care LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

QUALITY WOUND CARE LLC

Practice address

12022 Blue Valley Pkwy
Overland Park, KS 66213-2647

Phone

(913) 405-4416

NPI assigned

May 7, 2024

Last updated

May 7, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tiyamike EzalaNPI 1255902623

Title

President

Phone

(913) 405-4416

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tiyamike Ezala, NP

  • Family Medicine Physician
  • Olathe, KS
  • NPI 1255902623
  NPD Authorized official

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

{
    "created_epoch": "1715040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715040000000",
    "number": "1497503452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26061 W 150TH ST",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660618511",
            "telephone_number": "913-405-4416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12022 BLUE VALLEY PKWY",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662132647",
            "telephone_number": "913-405-4416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUALITY WOUND CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-07",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A",
        "authorized_official_last_name": "EZALA",
        "authorized_official_first_name": "TIYAMIKE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "913-405-4416"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Overland Park, KS
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.