Healthcare Provider Details

I. General information

NPI: 1558288050
Provider Name (Legal Business Name): VALENCIA BROADUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 ARROWHEAD AVE STE 208
INDEPENDENCE MO
64057-2681
US

IV. Provider business mailing address

PO BOX 270524
KANSAS CITY MO
64127-0524
US

V. Phone/Fax

Practice location:
  • Phone: 816-612-1083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: