Healthcare Provider Details

I. General information

NPI: 1710378666
Provider Name (Legal Business Name): KATHARINE CUNNINGHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5621 COTTONWOOD DR
SHAWNEE KS
66216-5009
US

IV. Provider business mailing address

5621 COTTONWOOD DR
SHAWNEE KS
66216-5009
US

V. Phone/Fax

Practice location:
  • Phone: 913-530-1265
  • Fax: 913-248-1714
Mailing address:
  • Phone: 913-530-1265
  • Fax: 913-248-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number14-118210-112
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2010034805
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: