Healthcare Provider Details

I. General information

NPI: 1831060466
Provider Name (Legal Business Name): KIDZMD DPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 RUSH CREEK PKWY STE B
LIBERTY MO
64068-9605
US

IV. Provider business mailing address

556 RUSH CREEK PKWY STE B
LIBERTY MO
64068-9605
US

V. Phone/Fax

Practice location:
  • Phone: 816-264-7576
  • Fax: 816-264-7578
Mailing address:
  • Phone: 816-264-7576
  • Fax: 816-264-7578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHELSEA JOHNSON
Title or Position: FOUNDER - PEDIATRICIAN
Credential: MD
Phone: 816-868-3045