Healthcare Provider Details

I. General information

NPI: 1841255064
Provider Name (Legal Business Name): KATHY J CHAMBERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 S 4TH ST L-120
LEAVENWORTH KS
66048-5014
US

IV. Provider business mailing address

4101 S 4TH ST L-120
LEAVENWORTH KS
66048-5014
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-2000
  • Fax: 913-758-4275
Mailing address:
  • Phone: 913-682-2000
  • Fax: 913-758-4276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number840
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: