Healthcare Provider Details

I. General information

NPI: 1215671029
Provider Name (Legal Business Name): LAURA ALLEN-MATLOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD # MS 1046
KANSAS CITY KS
66160-8500
US

IV. Provider business mailing address

2000 MEDICAL DR
LAKEWAY TX
78734-4200
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberW6156
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: