Healthcare Provider Details

I. General information

NPI: 1588690945
Provider Name (Legal Business Name): ABIGAIL R RAYNOLDS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 09/11/2025
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 TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number13-48978-101
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number097940
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number44902
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number097940
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: