Healthcare Provider Details

I. General information

NPI: 1023533288
Provider Name (Legal Business Name): KARA ROEDEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 SW EASTMAN CT
BLUE SPRINGS MO
64015-8738
US

IV. Provider business mailing address

14121 PARKE LONG CT
CHANTILLY VA
20151-1647
US

V. Phone/Fax

Practice location:
  • Phone: 816-500-5289
  • Fax:
Mailing address:
  • Phone: 816-500-5289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017027391
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: