Healthcare Provider Details

I. General information

NPI: 1164116521
Provider Name (Legal Business Name): KELSEY ANN YEAGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8640 N GREEN HILLS RD STE 43
KANSAS CITY MO
64154-1903
US

IV. Provider business mailing address

458 NE 291 HWY
LEES SUMMIT MO
64086-2501
US

V. Phone/Fax

Practice location:
  • Phone: 816-800-8020
  • Fax: 816-800-8029
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2513
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2024033359
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: