Provider Demographics
NPI:1598443459
Name:REED-COLE, KIMBERLY LASHAY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LASHAY
Last Name:REED-COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:LASHAY
Other - Last Name:BOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 NE 103RD TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-3548
Mailing Address - Country:US
Mailing Address - Phone:913-213-4954
Mailing Address - Fax:
Practice Address - Street 1:2 NE 103RD TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-3548
Practice Address - Country:US
Practice Address - Phone:913-213-4954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOL213012034172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver