Healthcare Provider Details

I. General information

NPI: 1073959979
Provider Name (Legal Business Name): METTA KATHERINE SIEBERT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: METTA KATHERINE THOMPSON NP

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108
US

IV. Provider business mailing address

2401 GILLHAM RD.
KANSAS CITY MO
64108
US

V. Phone/Fax

Practice location:
  • Phone: 816-760-5560
  • Fax: 816-302-9987
Mailing address:
  • Phone: 816-760-5560
  • Fax: 816-302-9987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number2013021884
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: