Healthcare Provider Details

I. General information

NPI: 1376806588
Provider Name (Legal Business Name): KELSEY LAINE ABLE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELSEY LAINE HARPSTER

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 N OAK TRFY STE 102
KANSAS CITY MO
64118-4600
US

IV. Provider business mailing address

17501 E 40 HWY STE 213A
INDEPENDENCE MO
64055-6445
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-4887
  • Fax: 816-478-7140
Mailing address:
  • Phone: 816-478-4887
  • Fax: 816-478-7140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9407993
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberFA5212911
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: