Healthcare Provider Details

I. General information

NPI: 1013737121
Provider Name (Legal Business Name): KRISTEN R NONDORF PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9416 N GRANBY AVE
KANSAS CITY MO
64154-1382
US

IV. Provider business mailing address

9416 N GRANBY AVE
KANSAS CITY MO
64154-1382
US

V. Phone/Fax

Practice location:
  • Phone: 816-810-1717
  • Fax:
Mailing address:
  • Phone: 816-810-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: