Healthcare Provider Details

I. General information

NPI: 1326982570
Provider Name (Legal Business Name): KATHERINE KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE KELLY MCCORMACK

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOLMES ST
KANSAS CITY MO
64108-2640
US

IV. Provider business mailing address

18070 NW 127TH CT
PLATTE CITY MO
64079-7816
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-4175
  • Fax: 816-404-0030
Mailing address:
  • Phone: 913-832-8318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: