Provider Demographics
NPI:1831437987
Name:TAGHIZADEH, MEHDI (APRN)
Entity type:Individual
Prefix:MR
First Name:MEHDI
Middle Name:
Last Name:TAGHIZADEH
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:MR
Other - First Name:MEHDI
Other - Middle Name:
Other - Last Name:TAGHIZADEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:14720 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2204
Mailing Address - Country:US
Mailing Address - Phone:913-685-1200
Mailing Address - Fax:913-685-1245
Practice Address - Street 1:14720 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2204
Practice Address - Country:US
Practice Address - Phone:913-685-1200
Practice Address - Fax:913-685-1245
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS102880163W00000X
KS53-75936-102363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse