Healthcare Provider Details

I. General information

NPI: 1730506684
Provider Name (Legal Business Name): ANIESA SLACK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10950 W 86TH ST
LENEXA KS
66214-1634
US

IV. Provider business mailing address

5675 ROE BLVD STE 100
ROELAND PARK KS
66205-2538
US

V. Phone/Fax

Practice location:
  • Phone: 913-722-4240
  • Fax: 913-721-0298
Mailing address:
  • Phone: 913-432-3780
  • Fax: 913-432-8463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-52035
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2017020535
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: