Individual
KYRA L REICHARDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1102 W 32ND STREET, STE 300, JOPLIN, MO 64804
(417) 782-3000
(417) 782-3088
Mailing address
PO BOX 3810, JOPLIN, MO 64803
(417) 782-3000
(417) 782-3088
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
129112
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100145070A
—
OK
05
—
100414280A
—
KS
01
—
162696
ANTHEM
MO
05
—
425753100
—
MO
01
—
500022358
RR MEDICARE
—
Enumeration date
06/18/2006
Last updated
10/29/2007
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