Healthcare Provider Details

I. General information

NPI: 1619243904
Provider Name (Legal Business Name): AUBREY ANN O'CONNOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 WORNALL RD STE 720
KANSAS CITY MO
64111-3248
US

IV. Provider business mailing address

4320 WORNALL RD STE 720
KANSAS CITY MO
64111-3248
US

V. Phone/Fax

Practice location:
  • Phone: 816-895-8442
  • Fax: 816-531-6025
Mailing address:
  • Phone: 816-895-8442
  • Fax: 816-531-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2016026088
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: