Provider Demographics
NPI:1194799916
Name:GROOM, LORI A (ARNP)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:A
Last Name:GROOM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 PROSPECT AVENUE
Mailing Address - Street 2:SUITE T-101
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1186
Mailing Address - Country:US
Mailing Address - Phone:816-363-4100
Mailing Address - Fax:816-363-8201
Practice Address - Street 1:6420 PROSPECT AVENUE
Practice Address - Street 2:SUITE T-101
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1186
Practice Address - Country:US
Practice Address - Phone:816-363-4100
Practice Address - Fax:816-363-8201
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO095696363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS54748Medicare UPIN
MO523E269Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER