Healthcare Provider Details

I. General information

NPI: 1972434801
Provider Name (Legal Business Name): KIMBRIE ANA-SHU PUTNAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMI PUTNAM

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23351 PRAIRIE STAR PKWY STE A125
LENEXA KS
66227-7303
US

IV. Provider business mailing address

4901 N ROUTE E
COLUMBIA MO
65202-7814
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-8610
  • Fax:
Mailing address:
  • Phone: 573-289-6579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number208100000X
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: