1003474347 NPI number — LAURA SHELBY REYNOLDS CAA

Table of content: LAURA SHELBY REYNOLDS CAA (NPI 1003474347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003474347 NPI number — LAURA SHELBY REYNOLDS CAA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYNOLDS
Provider First Name:
LAURA
Provider Middle Name:
SHELBY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CAA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPEARS
Provider Other First Name:
LAURA
Provider Other Middle Name:
SHELBY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003474347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 AVENIDA CESAR E CHAVEZ APT 245
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64108-2399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-805-1056
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 WORNALL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-3241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-932-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2019

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: 367H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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