Healthcare Provider Details

I. General information

NPI: 1104757228
Provider Name (Legal Business Name): MS. HEATHER LYNN PAX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 101ST TER
KANSAS CITY MO
64131-5322
US

IV. Provider business mailing address

916 SW ROBIN CIR
BLUE SPRINGS MO
64015-5455
US

V. Phone/Fax

Practice location:
  • Phone: 816-371-4180
  • Fax:
Mailing address:
  • Phone: 816-248-3458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: