Healthcare Provider Details

I. General information

NPI: 1033379771
Provider Name (Legal Business Name): KATHY MARIE PERSELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 NE COOKSON ST
LEES SUMMIT MO
64086-6307
US

IV. Provider business mailing address

2027 NE COOKSON ST
LEES SUMMIT MO
64086-6307
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-0386
  • Fax: 816-246-1664
Mailing address:
  • Phone: 816-525-0386
  • Fax: 816-246-1664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1482353011
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: