Provider Demographics
NPI:1881652683
Name:KEITH, LAURA D (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:D
Last Name:KEITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:DANIELLE
Other - Last Name:KEITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:5501 NW 62ND TER STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2412
Mailing Address - Country:US
Mailing Address - Phone:816-842-4440
Mailing Address - Fax:816-842-1974
Practice Address - Street 1:5501 NW 62ND TER STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2412
Practice Address - Country:US
Practice Address - Phone:816-842-4440
Practice Address - Fax:816-842-1974
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO136698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily