Healthcare Provider Details

I. General information

NPI: 1326903030
Provider Name (Legal Business Name): MARY NEVELS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 BLUE RIDGE BLVD
RAYTOWN MO
64133-5629
US

IV. Provider business mailing address

1555 NE RICE RD
LEES SUMMIT MO
64086-5849
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-4261
  • Fax:
Mailing address:
  • Phone: 816-554-4261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2023034530
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: