Healthcare Provider Details

I. General information

NPI: 1205641123
Provider Name (Legal Business Name): ANNA CAUDLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 E LINWOOD BLVD
KANSAS CITY MO
64128-2226
US

IV. Provider business mailing address

302 PINE AVE
DENTON KS
66017-4000
US

V. Phone/Fax

Practice location:
  • Phone: 816-861-4700
  • Fax:
Mailing address:
  • Phone: 913-360-0277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number14-125255-122
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: