Healthcare Provider Details

I. General information

NPI: 1306413968
Provider Name (Legal Business Name): PEYTON NICOLE BENNETT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 N OAK TRFY STE 200
KANSAS CITY MO
64118-4690
US

IV. Provider business mailing address

9411 N OAK TRFY STE LL1
KANSAS CITY MO
64155-2262
US

V. Phone/Fax

Practice location:
  • Phone: 816-453-0900
  • Fax: 816-453-3895
Mailing address:
  • Phone: 816-691-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2024030448
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: