Healthcare Provider Details

I. General information

NPI: 1376554337
Provider Name (Legal Business Name): KATHRYN RYAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W RD MIZE RD SUITE 304
BLUE SPRINGS MO
64014-2515
US

IV. Provider business mailing address

PO BOX 8035
WICHITA KS
67208-0035
US

V. Phone/Fax

Practice location:
  • Phone: 816-228-4770
  • Fax: 816-228-1156
Mailing address:
  • Phone: 316-689-9135
  • Fax: 316-689-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number74749
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: