Healthcare Provider Details

I. General information

NPI: 1982036570
Provider Name (Legal Business Name): KEVIN BLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 NEWPORT RD
SAINT JOSEPH MO
64505-1881
US

IV. Provider business mailing address

2919 NEWPORT RD
SAINT JOSEPH MO
64505-1881
US

V. Phone/Fax

Practice location:
  • Phone: 417-629-8955
  • Fax:
Mailing address:
  • Phone: 417-629-8955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: