Provider Demographics
NPI:1417374828
Name:RAGLAND, MERLON (B,S,W,)
Entity Type:Individual
Prefix:
First Name:MERLON
Middle Name:
Last Name:RAGLAND
Suffix:
Gender:F
Credentials:B,S,W,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6633 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1201
Mailing Address - Country:US
Mailing Address - Phone:816-616-2652
Mailing Address - Fax:
Practice Address - Street 1:6633 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1201
Practice Address - Country:US
Practice Address - Phone:816-616-2652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X, 172V00000X
MO174H00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No171M00000XOther Service ProvidersCase Manager/Care Coordinator