Healthcare Provider Details

I. General information

NPI: 1255923231
Provider Name (Legal Business Name): CECILY A. CLARK-GANHEART, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16240 FOSTER ST
OVERLAND PARK KS
66085-8418
US

IV. Provider business mailing address

16240 FOSTER ST
OVERLAND PARK KS
66085-8418
US

V. Phone/Fax

Practice location:
  • Phone: 269-209-2048
  • Fax:
Mailing address:
  • Phone: 913-291-0069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CECILY ANNE CLARK-GANHEART
Title or Position: PRESIDENT
Credential: MD
Phone: 913-291-0069