Healthcare Provider Details

I. General information

NPI: 1669389771
Provider Name (Legal Business Name): BETHANY CARDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
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

5242 LUCILLE LN
SHAWNEE KS
66203-1474
US

V. Phone/Fax

Practice location:
  • Phone: 816-347-4912
  • Fax:
Mailing address:
  • Phone: 913-263-2353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3-116746
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: