Healthcare Provider Details

I. General information

NPI: 1730636671
Provider Name (Legal Business Name): LATANYA RAYMOND MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5559 NW BARRY RD SUITE 345
KANSAS CITY MO
64154-1408
US

IV. Provider business mailing address

5559 NW BARRY RD SUITE 345
KANSAS CITY MO
64154-1408
US

V. Phone/Fax

Practice location:
  • Phone: 314-619-0293
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: