Healthcare Provider Details

I. General information

NPI: 1205819398
Provider Name (Legal Business Name): KATHLEEN ERIN PINON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: KATHLEEN ERIN TEEL RN

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 NE RALPH POWELL RD
LEES SUMMIT MO
64064-2357
US

IV. Provider business mailing address

3601 NE RALPH POWELL RD
LEES SUMMIT MO
64064-2357
US

V. Phone/Fax

Practice location:
  • Phone: 816-251-1200
  • Fax: 816-251-1280
Mailing address:
  • Phone: 816-251-1200
  • Fax: 816-251-1280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number089582
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: