Provider Demographics
NPI:1639657547
Name:SWAFFORD, LAURA FAE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:FAE
Last Name:SWAFFORD
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 1:1178 MEADOW BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ARRINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:37014-9108
Mailing Address - Country:US
Mailing Address - Phone:816-260-1812
Mailing Address - Fax:
Practice Address - Street 1:8600 W 95TH ST STE 207
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-3240
Practice Address - Country:US
Practice Address - Phone:913-642-6151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201135240AMedicaid