Healthcare Provider Details

I. General information

NPI: 1699250621
Provider Name (Legal Business Name): HEARTLAND WEIGHT LOSS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14205 METCALF AVE
OVERLAND PARK KS
66223-3367
US

IV. Provider business mailing address

14205 METCALF AVE
OVERLAND PARK KS
66223-3367
US

V. Phone/Fax

Practice location:
  • Phone: 913-620-1616
  • Fax: 913-624-3848
Mailing address:
  • Phone: 913-620-1616
  • Fax: 913-624-3848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY YOUNGLOVE
Title or Position: OWNER / MEDICAL DIRECTOR
Credential: MD
Phone: 913-915-5004