Provider Demographics
NPI:1003474347
Name:REYNOLDS, LAURA SHELBY (CAA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SHELBY
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:SHELBY
Other - Last Name:SPEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 AVENIDA CESAR E CHAVEZ APT 245
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2399
Mailing Address - Country:US
Mailing Address - Phone:816-805-1056
Mailing Address - Fax:
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3241
Practice Address - Country:US
Practice Address - Phone:816-932-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-02
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant