Healthcare Provider Details

I. General information

NPI: 1093446296
Provider Name (Legal Business Name): ANNE KELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10456 MASTIN ST
OVERLAND PARK KS
66212-5701
US

IV. Provider business mailing address

3965 W 83RD ST STE 157
PRAIRIE VILLAGE KS
66208-5308
US

V. Phone/Fax

Practice location:
  • Phone: 913-735-3393
  • Fax:
Mailing address:
  • Phone: 913-735-3393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2026004360
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA00949
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: