1124252242 NPI number — MRS. SHERYL LYNN LAVELOCK M.S., PLPC

Table of content: MRS. SHERYL LYNN LAVELOCK M.S., PLPC (NPI 1124252242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124252242 NPI number — MRS. SHERYL LYNN LAVELOCK M.S., PLPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAVELOCK
Provider First Name:
SHERYL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., PLPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GILLILAND
Provider Other First Name:
SHERYL
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124252242
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/11/2012
NPI Reactivation Date:
03/15/2021

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19819 S HICKORY GROVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLEASANT HILL
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64080-9134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-726-2320
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4635 WYANDOTTE ST
Provider Second Line Business Practice Location Address:
STE. 204
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64112-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-726-2320
Provider Business Practice Location Address Fax Number:
816-561-2100
Provider Enumeration Date:
05/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  2009008725 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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