Healthcare Provider Details

I. General information

NPI: 1891455630
Provider Name (Legal Business Name): KERRI ANNE OBRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 N 291 HWY
LIBERTY MO
64068-1045
US

IV. Provider business mailing address

5863 NW 72ND ST
KANSAS CITY MO
64151-1483
US

V. Phone/Fax

Practice location:
  • Phone: 816-384-0099
  • Fax:
Mailing address:
  • Phone: 816-984-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: