Healthcare Provider Details

I. General information

NPI: 1669477204
Provider Name (Legal Business Name): HUNTER TODD FEASTER PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 MARSHALL DR STE 100
LENEXA KS
66214-1505
US

IV. Provider business mailing address

8550 MARSHALL DR STE 100
LENEXA KS
66214-1505
US

V. Phone/Fax

Practice location:
  • Phone: 913-894-1500
  • Fax: 913-894-1502
Mailing address:
  • Phone: 913-894-1500
  • Fax: 913-894-1502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberLP1161
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2002007821
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: