Sue Ellen Breese, ANP-BC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

2001005022 Issued in MO

Practice address

5950 N. Oak Trfy
Suite 104
Kansas City, MO 64118-5164

Phone

(816) 268-8501

Fax

(816) 452-5700

NPI assigned

Dec 19, 2007

Last updated

Apr 19, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• Sue Ellen Ray Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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

• Northland Psychological Associates LLC

  dba Dipoto Counseling Group

  • Mental Health Counselor
  • Liberty, MO
  • NPI 1649453663
  NPD (past)
• Kansas City Cancer Center, LLC

  • Medical Oncology Physician
  • Overland Park, KS
  • NPI 1003864471
  NPD (past)

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

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650326400000",
    "number": "1679757116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5950 N OAK TRFY STE 104",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641185164",
            "telephone_number": "816-268-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5950 N. OAK TRFY",
            "address_2": "SUITE 104",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641185164",
            "telephone_number": "816-268-8501",
            "fax_number": "816-452-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREESE",
        "first_name": "SUE",
        "middle_name": "ELLEN",
        "credential": "ANP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-19",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "KS",
            "license": "53-46184-042",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2001005022",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2001005022",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KS",
            "license": "14-97852-042",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2001005022",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679757116",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200633510B",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUE",
            "last_name": "RAY",
            "middle_name": "ELLEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ashley Breaux, FNP-BC
• Marci A Brecheisen, MD
• Jeffrey A Bredemann, MD
• Kelsey Nicole Breedlove, AU.D.
• Sophia Lynn Breedlove, PA-C
• Abby Breithaupt
• Roxane S Bremen, D.O.
• Brooklyn Renee Brende, ACCNS-AG
• Shanna Brende, M.A., L.P.C.
• Leah Brendel, OTR/L

• Adult Health Nurse Practitioner in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Adult Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; 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.