Healthcare Provider Details

I. General information

NPI: 1780941088
Provider Name (Legal Business Name): SHANIKA TAYLOR-FIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 01/26/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 E MEYER BLVD
KANSAS CITY MO
64132-1136
US

IV. Provider business mailing address

2316 E MEYER BLVD
KANSAS CITY MO
64132-1136
US

V. Phone/Fax

Practice location:
  • Phone: 816-276-4360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2004021637
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: