Individual provider Active NPI

Kendra Rachelle Null, O.D.

  • Optometrist
  • Kansas City, MO
National Provider Identifier
1609131598
Registry record updated Feb 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2015035194 Issued in MO
Practice address
4801 E Linwood Blvd
Kansas City, MO 64128-2226
Phone
(816) 861-4700
Fax
(816) 922-3382
NPI assigned
Jul 7, 2012
Last updated
Feb 28, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 089984 IA
Optometrist 152W00000X 3063 TN
Optometrist 152W00000X 2015035194 MO Primary

Addresses

Primary practice location

4801 E Linwood Blvd
Kansas City, MO 64128-2226

Mailing address

594 Calla Lilly Way
Tiffin, IA 52340-9236
Phone (901) 483-5633

Other names 1

  • Dr. Kendra Rachelle Dalton Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
089984IAMDOptometrist
2015035194MOMDOptometrist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551312000000",
    "number": "1609131598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "594 CALLA LILLY WAY",
            "city": "TIFFIN",
            "state": "IA",
            "postal_code": "523409236",
            "telephone_number": "901-483-5633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 E LINWOOD BLVD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641282226",
            "telephone_number": "816-861-4700",
            "fax_number": "816-922-3382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NULL",
        "first_name": "KENDRA",
        "middle_name": "RACHELLE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-07",
        "last_updated": "2019-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "089984",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "3063",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2015035194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENDRA",
            "last_name": "DALTON",
            "middle_name": "RACHELLE",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kansas City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.