Healthcare Provider Details

I. General information

NPI: 1720234107
Provider Name (Legal Business Name): CECILY ANNE CLARK-GANHEART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2008
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16240 FOSTER ST
STILWELL KS
66085-8418
US

IV. Provider business mailing address

6085 W 183RD ST
OVERLAND PARK KS
66085-8741
US

V. Phone/Fax

Practice location:
  • Phone: 913-291-0069
  • Fax: 913-291-0070
Mailing address:
  • Phone: 269-209-2048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberABCDEFG1
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD040474
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number0438153
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number2015021377
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: