Healthcare Provider Details

I. General information

NPI: 1093004665
Provider Name (Legal Business Name): JONAH WALKER GARRETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NE SAINT LUKES BLVD
LEES SUMMIT MO
64086-6000
US

IV. Provider business mailing address

15737 FALMOUTH ST
OVERLAND PARK KS
66224-3844
US

V. Phone/Fax

Practice location:
  • Phone: 816-347-5097
  • Fax:
Mailing address:
  • Phone: 479-925-8914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number04-43071
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2015010082
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: