Basic Information
| Provider Information | |||||||||
| NPI: | 1801441373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARD | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | BSN, RN, CCRN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 E 104TH ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641314517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165999499 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9107 NW 45 HWY | ||||||||
| Address2: | |||||||||
| City: | PARKVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641523958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162515775 | ||||||||
| FaxNumber: | 8162515776 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2019 | ||||||||
| LastUpdateDate: | 07/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 2013019484 | MO | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 363LF0000X | 53-79233 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 2020000702 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.