Healthcare Provider Details

I. General information

NPI: 1043334105
Provider Name (Legal Business Name): KANSAS CITY GASTROENTEROLOGY & HEPATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6675 HOLMES RD STE 430
KANSAS CITY MO
64131-1167
US

IV. Provider business mailing address

6675 HOLMES RD STE 430
KANSAS CITY MO
64131-1167
US

V. Phone/Fax

Practice location:
  • Phone: 816-361-0055
  • Fax: 816-361-5775
Mailing address:
  • Phone: 816-361-0055
  • Fax: 816-361-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number105860
License Number StateMO

VIII. Authorized Official

Name: JANAY KISSINGER
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 816-361-0055