Healthcare Provider Details

I. General information

NPI: 1689508129
Provider Name (Legal Business Name): MYSPACE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NE HENDRIX DR
LEES SUMMIT MO
64086-3519
US

IV. Provider business mailing address

1309 COFFEEN AVE STE 17117
SHERIDAN WY
82801-5777
US

V. Phone/Fax

Practice location:
  • Phone: 816-624-2094
  • Fax: 816-207-0484
Mailing address:
  • Phone: 816-623-0580
  • Fax: 816-207-0484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CASSEY LYNN HALL
Title or Position: DNP, FNP-C OWNER
Credential: HALL
Phone: 816-624-2094