Healthcare Provider Details

I. General information

NPI: 1932703568
Provider Name (Legal Business Name): KERRY MAGUIRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 DR MARTIN LUTHER KING JR BLVD
KANSAS CITY MO
64130-2870
US

IV. Provider business mailing address

4400 DR MARTIN LUTHER KING JR BLVD
KANSAS CITY MO
64130-2870
US

V. Phone/Fax

Practice location:
  • Phone: 816-501-5138
  • Fax:
Mailing address:
  • Phone: 816-501-5138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2024018040
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: