Healthcare Provider Details

I. General information

NPI: 1063440303
Provider Name (Legal Business Name): KATHLEEN RAE MCBRATNEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 PROGRESS DRIVE SUITE 200
LANSING KS
66043-5323
US

IV. Provider business mailing address

1004 PROGRESS DRIVE SUITE 200
LANSING KS
66043-5323
US

V. Phone/Fax

Practice location:
  • Phone: 913-651-3111
  • Fax: 913-651-3103
Mailing address:
  • Phone: 913-651-3111
  • Fax: 913-651-3103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number04-20753
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: