1598498453 NPI number — MRS. ALEXANDRA MAE GREGG RD, LD

Table of content: MRS. ALEXANDRA MAE GREGG RD, LD (NPI 1598498453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598498453 NPI number — MRS. ALEXANDRA MAE GREGG RD, LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREGG
Provider First Name:
ALEXANDRA
Provider Middle Name:
MAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598498453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8450 NW PR VW RD # 1441
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:
64153-1841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-990-4403
Provider Business Mailing Address Fax Number:
507-322-1832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2420 SW WINTERFIELD CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEES SUMMIT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64081-4098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-875-0077
Provider Business Practice Location Address Fax Number:
507-322-1832
Provider Enumeration Date:
07/07/2022

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: 133V00000X , with the licence number:  2022025851 , 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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