Healthcare Provider Details

I. General information

NPI: 1619802790
Provider Name (Legal Business Name): TAYLOR FORTUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 NE KENDALLWOOD PKWY
KANSAS CITY MO
64119-2173
US

IV. Provider business mailing address

1918 NW 82ND TER
KANSAS CITY MO
64151-8226
US

V. Phone/Fax

Practice location:
  • Phone: 573-515-3747
  • Fax:
Mailing address:
  • Phone: 816-863-4810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2026027580
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: