Provider Demographics
NPI:1639834682
Name:KING, LAURIBETH H (APRN)
Entity Type:Individual
Prefix:
First Name:LAURIBETH
Middle Name:H
Last Name:KING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LAURIBETH
Other - Middle Name:H
Other - Last Name:AGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3340 NE RALPH POWELL RD STE B
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2368
Mailing Address - Country:US
Mailing Address - Phone:816-875-2599
Mailing Address - Fax:
Practice Address - Street 1:6815 FRONTAGE RD STE A
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-1555
Practice Address - Country:US
Practice Address - Phone:913-721-3387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021042806363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner