Healthcare Provider Details

I. General information

NPI: 1720258122
Provider Name (Legal Business Name): BETHANY A AUSTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 WORNALL RD SUITE 2000
KANSAS CITY MO
64111
US

IV. Provider business mailing address

901 E 104TH ST MAILSTOP 400S
KANSAS CITY MO
64131
US

V. Phone/Fax

Practice location:
  • Phone: 816-931-1883
  • Fax: 816-756-3645
Mailing address:
  • Phone: 816-931-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2010011906
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number2010011906
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: