Healthcare Provider Details

I. General information

NPI: 1033428735
Provider Name (Legal Business Name): ANNA LAUREL SHORT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 913-432-2080
  • Fax: 913-432-5183
Mailing address:
  • Phone: 913-432-2080
  • Fax: 913-432-5183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-75214-101
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number53-75214-101
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: