Healthcare Provider Details

I. General information

NPI: 1720418874
Provider Name (Legal Business Name): HEALTHY LIVING FIRST MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 N 38TH ST
KANSAS CITY KS
66102-2229
US

IV. Provider business mailing address

1202 N 38TH ST
KANSAS CITY KS
66102-2229
US

V. Phone/Fax

Practice location:
  • Phone: 913-777-7600
  • Fax: 913-777-7619
Mailing address:
  • Phone: 913-777-7600
  • Fax: 913-777-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ALANNA HUNTER LEE
Title or Position: PHYSICIAN, OWNER
Credential: MD
Phone: 913-777-7600