Basic Information
Provider Information
NPI: 1285288092
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROBERTS
FirstName: ALLISON
MiddleName: PAIGE
NamePrefix:  
NameSuffix:  
Credential: AGACNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3901 RAINBOW BLVD
Address2:  
City: KANSAS CITY
State: KS
PostalCode: 661608500
CountryCode: US
TelephoneNumber: 9135886970
FaxNumber: 9135886965
Practice Location
Address1: 4000 CAMBRIDGE ST
Address2:  
City: KANSAS CITY
State: KS
PostalCode: 661608501
CountryCode: US
TelephoneNumber: 9135881227
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/30/2019
LastUpdateDate: 07/30/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100XTMP-158797KSY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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