Healthcare Provider Details

I. General information

NPI: 1235705385
Provider Name (Legal Business Name): MIKAYLA MARIE MOODY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIKAYLA MARIE MEYER

II. Dates (important events)

Enumeration Date: 05/30/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD # MS 2005
KANSAS CITY KS
66160-8500
US

IV. Provider business mailing address

3901 RAINBOW BLVD # MS 2005
KANSAS CITY KS
66160-8500
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6124
  • Fax: 913-588-7540
Mailing address:
  • Phone: 913-588-6124
  • Fax: 913-588-7540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number94-12587
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: