Healthcare Provider Details

I. General information

NPI: 1144848524
Provider Name (Legal Business Name): MOLLY KATHRYN GILMORE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2020
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8625 COLLEGE BLVD STE 103
OVERLAND PARK KS
66210-2192
US

IV. Provider business mailing address

28307 W 162ND ST
GARDNER KS
66030-8546
US

V. Phone/Fax

Practice location:
  • Phone: 913-777-0077
  • Fax:
Mailing address:
  • Phone: 913-302-2521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-79423-042
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: