Provider Demographics
NPI:1326392259
Name:WADDELL, LAURA A (ARNP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:A
Last Name:WADDELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8600 NE 82ND ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158-1430
Mailing Address - Country:US
Mailing Address - Phone:816-741-9122
Mailing Address - Fax:
Practice Address - Street 1:8600 NE 82ND ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-1430
Practice Address - Country:US
Practice Address - Phone:816-741-9122
Practice Address - Fax:816-741-9665
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF-132474363LW0102X
MO2024008961363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health