Healthcare Provider Details

I. General information

NPI: 1356283428
Provider Name (Legal Business Name): JEFFERY DANE CLUTTER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD MS 1045
KANSAS CITY KS
66160
US

IV. Provider business mailing address

3901 RAINBOW BLVD MS 1045
KANSAS CITY KS
66160
US

V. Phone/Fax

Practice location:
  • Phone: 816-438-1360
  • Fax:
Mailing address:
  • Phone: 816-438-1360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number94-12748
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: