Healthcare Provider Details

I. General information

NPI: 1942956743
Provider Name (Legal Business Name): KATELYN MARIE WAITS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CAMBRIDGE ST
KANSAS CITY KS
66160-8501
US

IV. Provider business mailing address

10005 N LEWIS AVE
KANSAS CITY MO
64157-7877
US

V. Phone/Fax

Practice location:
  • Phone: 913-972-0371
  • Fax:
Mailing address:
  • Phone: 913-972-0371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53-80485-022
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2021034995
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number2021034995
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number53-80485-022
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: