Healthcare Provider Details

I. General information

NPI: 1023439304
Provider Name (Legal Business Name): ALISHA CUPID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date: 11/07/2014
Reactivation Date: 11/10/2015

III. Provider practice location address

7340 LEAVENWORTH RD
KANSAS CITY KS
66109-1226
US

IV. Provider business mailing address

7340 LEAVENWORTH RD
KANSAS CITY KS
66109-1226
US

V. Phone/Fax

Practice location:
  • Phone: 913-627-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: