Healthcare Provider Details

I. General information

NPI: 1841607900
Provider Name (Legal Business Name): SHAYLA SANDERS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 WESTPORT RD
KANSAS CITY MO
64111-4366
US

IV. Provider business mailing address

12721 EAGLE DR
POLLOCK MO
63560-2612
US

V. Phone/Fax

Practice location:
  • Phone: 816-282-0131
  • Fax: 816-282-0136
Mailing address:
  • Phone: 660-265-5879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014023980
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: