Provider Demographics
NPI:1487997110
Name:SEGRAVES, ANDREW (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:SEGRAVES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 STATE LINE ROAD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-7213
Mailing Address - Country:US
Mailing Address - Phone:913-385-7252
Mailing Address - Fax:
Practice Address - Street 1:8900 STATE LINE RD STE 380
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-1936
Practice Address - Country:US
Practice Address - Phone:913-385-7252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170000682084P0800X
KS05-396212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry