Healthcare Provider Details

I. General information

NPI: 1356496442
Provider Name (Legal Business Name): RUTH A KIEKHAEFER PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 N RIVERSIDE RD STE 100
SAINT JOSEPH MO
64507-2566
US

IV. Provider business mailing address

902 N RIVERSIDE RD STE 100
SAINT JOSEPH MO
64507-2566
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-1360
  • Fax: 816-271-1355
Mailing address:
  • Phone: 816-271-1360
  • Fax: 816-271-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number077613
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: