Provider Demographics
NPI:1922110030
Name:PAGE-GOERTZ, SALLIE S (ARNP)
Entity type:Individual
Prefix:
First Name:SALLIE
Middle Name:S
Last Name:PAGE-GOERTZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 OLATHE BLVD MS 4004
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-6300
Mailing Address - Fax:913-274-3515
Practice Address - Street 1:2000 OLATHE BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6300
Practice Address - Fax:913-274-3515
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-36811-072363L00000X
KS74274363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100340290AMedicaid
KS636910OtherFIRSTGUARD
MO424966406Medicaid
500011376OtherRAILROAD MEDICARE