Provider Demographics
NPI:1225327323
Name:MASTERS, LYLA R (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LYLA
Middle Name:R
Last Name:MASTERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 CARONDELET DR STE 224A
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4822
Mailing Address - Country:US
Mailing Address - Phone:913-563-6644
Mailing Address - Fax:816-943-6122
Practice Address - Street 1:1010 CARONDELET DR STE 224A
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4822
Practice Address - Country:US
Practice Address - Phone:913-563-6644
Practice Address - Fax:816-943-6122
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019029220363LF0000X
MOF0311009363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019029220OtherMISSOURI STATE BOARD OF NURSING
MOF0311009OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS