Healthcare Provider Details

I. General information

NPI: 1659902880
Provider Name (Legal Business Name): BARBARA DIANN KELLY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/14/2021
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E 104TH ST
KANSAS CITY MO
64131-4517
US

IV. Provider business mailing address

901 E 104TH ST
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 816-251-5700
  • Fax:
Mailing address:
  • Phone: 816-251-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-79016-052
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: