Healthcare Provider Details

I. General information

NPI: 1558637298
Provider Name (Legal Business Name): LAURA ELIZABETH KRESTA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 LEES SUMMIT RD
KANSAS CITY MO
64139-1236
US

IV. Provider business mailing address

7900 LEES SUMMIT RD
KANSAS CITY MO
64139-1236
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-9030
  • Fax: 816-404-9001
Mailing address:
  • Phone: 816-404-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2015001244
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: