Healthcare Provider Details

I. General information

NPI: 1871303966
Provider Name (Legal Business Name): KATHLEEN MARIE JOHNSTON RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8781 N PLATTE PURCHASE DR
KANSAS CITY MO
64155-1829
US

IV. Provider business mailing address

7800 NE 127TH ST
KANSAS CITY MO
64167-1031
US

V. Phone/Fax

Practice location:
  • Phone: 816-587-3200
  • Fax:
Mailing address:
  • Phone: 816-809-8185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-17585
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: