Healthcare Provider Details

I. General information

NPI: 1609417559
Provider Name (Legal Business Name): KATHRYN RAE TESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN RAE BRUMBAUGH

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14844 W 107TH ST
LENEXA KS
66215-4002
US

IV. Provider business mailing address

10330 HICKMAN MILLS DR
KANSAS CITY MO
64137-1618
US

V. Phone/Fax

Practice location:
  • Phone: 720-575-9340
  • Fax:
Mailing address:
  • Phone: 816-501-5138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number3075
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2023013821
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number00549
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: