Healthcare Provider Details

I. General information

NPI: 1104962158
Provider Name (Legal Business Name): KATHRYN ANNE CARMICHAEL COULSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN A CARMICHAEL MD

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GLENN HENDREN DR
LIBERTY MO
64068-9625
US

IV. Provider business mailing address

2626 GLENN HENDREN DRIVE
LIBERTY MO
64068
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-1000
  • Fax:
Mailing address:
  • Phone: 816-792-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2004012226
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: