Healthcare Provider Details

I. General information

NPI: 1124955414
Provider Name (Legal Business Name): KRISTINA ELESE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 ANTIOCH RD
OVERLAND PARK KS
66213-2827
US

IV. Provider business mailing address

606 17TH AVE N
GREENWOOD MO
64034-9801
US

V. Phone/Fax

Practice location:
  • Phone: 913-825-9600
  • Fax:
Mailing address:
  • Phone: 816-516-4124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number05268
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: