Provider Demographics
NPI:1376937979
Name:CALVERT, CANDI
Entity Type:Individual
Prefix:
First Name:CANDI
Middle Name:
Last Name:CALVERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 CLAY EDWARDS DR STE 520
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3274
Mailing Address - Country:US
Mailing Address - Phone:816-221-6750
Mailing Address - Fax:816-221-2335
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 520
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3274
Practice Address - Country:US
Practice Address - Phone:816-221-6750
Practice Address - Fax:816-221-2335
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015000404363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1376937979Medicaid
MO1376937979Medicaid