Healthcare Provider Details

I. General information

NPI: 1114407525
Provider Name (Legal Business Name): KOURTNEY HALFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 02/16/2025
Certification Date: 02/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 WOLLARD BLVD
RICHMOND MO
64085-1974
US

IV. Provider business mailing address

5033 NW NANTUCKET DR
BLUE SPRINGS MO
64015-3887
US

V. Phone/Fax

Practice location:
  • Phone: 816-470-2131
  • Fax:
Mailing address:
  • Phone: 816-682-4298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08180219
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: