Healthcare Provider Details

I. General information

NPI: 1598724726
Provider Name (Legal Business Name): KELLY RENEE ALFORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6530 TROOST STE A
KANSAS CITY MO
64131
US

IV. Provider business mailing address

6530 TROOST STE A
KANSAS CITY MO
64131
US

V. Phone/Fax

Practice location:
  • Phone: 816-361-0670
  • Fax: 816-444-6936
Mailing address:
  • Phone: 816-361-0670
  • Fax: 816-444-6936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2004007601
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0429622
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: