Healthcare Provider Details

I. General information

NPI: 1396729133
Provider Name (Legal Business Name): ANGELA LYNN REYNOLDS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA KELLER

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6830 ANDERSON ST
SHAWNEE KS
66226-3101
US

IV. Provider business mailing address

6830 ANDERSON ST
SHAWNEE KS
66226-3101
US

V. Phone/Fax

Practice location:
  • Phone: 816-922-2750
  • Fax:
Mailing address:
  • Phone: 168-922-2750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number153633
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number14-147910-062
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: