Healthcare Provider Details

I. General information

NPI: 1346376027
Provider Name (Legal Business Name): KELLY J BEDFORD R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 1ST ST
PECULIAR MO
64078-9572
US

IV. Provider business mailing address

920 E 1ST ST
PECULIAR MO
64078-9572
US

V. Phone/Fax

Practice location:
  • Phone: 816-679-8446
  • Fax:
Mailing address:
  • Phone: 816-679-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number148860
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: