Healthcare Provider Details

I. General information

NPI: 1174225056
Provider Name (Legal Business Name): ALYSSA MONDEAUX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GLENN HENDREN DR
LIBERTY MO
64068-9600
US

IV. Provider business mailing address

2525 GLENN HENDREN DR
LIBERTY MO
64068-9600
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-7200
  • Fax:
Mailing address:
  • Phone: 816-781-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2026028285
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026028285
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: