Provider Demographics
NPI:1679118087
Name:GRIMES, KENDRA JEANNE (RN, LMT)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:JEANNE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 NW PRAIRIE VIEW RD STE 130
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-3808
Mailing Address - Country:US
Mailing Address - Phone:816-682-0164
Mailing Address - Fax:
Practice Address - Street 1:7000 NW PRAIRIE VIEW RD STE 130
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-3808
Practice Address - Country:US
Practice Address - Phone:816-682-0164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010025794225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist