Healthcare Provider Details

I. General information

NPI: 1336093830
Provider Name (Legal Business Name): WESTPORT SERENITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 WESTPORT RD
KANSAS CITY MO
64111-4327
US

IV. Provider business mailing address

4901 W 136TH ST
LEAWOOD KS
66224-5926
US

V. Phone/Fax

Practice location:
  • Phone: 913-890-7280
  • Fax: 913-387-2023
Mailing address:
  • Phone: 913-626-1979
  • Fax: 913-387-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JEHREN RANEY
Title or Position: CEO
Credential:
Phone: 913-626-1979