Healthcare Provider Details

I. General information

NPI: 1366641847
Provider Name (Legal Business Name): KAREN ANN WEDLOCK RN,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 HEARTLAND RD., STE. 4860
SAINT JOSEPH MO
64506-6202
US

IV. Provider business mailing address

901 HEARTLAND RD., STE. 4860
SAINT JOSEPH MO
64506-6202
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-6700
  • Fax: 816-271-6701
Mailing address:
  • Phone: 816-271-6700
  • Fax: 816-271-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number109982
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: