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NPI Code Detail

MEDICARE: JANE REARDON

MEDICARE: JANE REARDON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianR9F52MO

General Provider Information

NPI Number : 1134780430
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE REARDON
Provider Business Mailing Address
First Line : 10423 RIDGEVIEW AVE
Second Line :
City : LIBERTY
State : MO
Zip : 64068-7304
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8140 WARD PKWY STE 275
Second Line :
City : KANSAS CITY
State : MO
Zip : 64114-2032
Country : US
Telephone Number : 855-355-7058
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2019
Last Update Date : 06/26/2019

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