Healthcare Provider Details

I. General information

NPI: 1316542749
Provider Name (Legal Business Name): HEALING AT THE ROOT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 SE MOORE ST
BLUE SPRINGS MO
64014-3127
US

IV. Provider business mailing address

129 SE MOORE ST
BLUE SPRINGS MO
64014-3127
US

V. Phone/Fax

Practice location:
  • Phone: 816-924-8183
  • Fax:
Mailing address:
  • Phone: 816-924-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State

VIII. Authorized Official

Name: SHARANDELL RENA WALLACE
Title or Position: CEO
Credential:
Phone: 816-924-8183