Healthcare Provider Details

I. General information

NPI: 1518916030
Provider Name (Legal Business Name): CHRISTINE MARY WALSH-KELLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

13130 WATERTOWN PLANK RD UNIT 103
ELM GROVE WI
53122-2237
US

V. Phone/Fax

Practice location:
  • Phone: 816-234-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number2005026118
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: