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General NPI Number Information
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NPI Number | 1043329147
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Entity Type | Individual
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Provider Name | KELLY J HENDRICKS M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 5701 W 119TH ST STE 410
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City | OVERLAND PARK
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State | KS
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Zip | 66209-3721
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Country | US
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Telephone | 913-345-6901
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Fax | 913-469-4095
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Provider Business Mailing Address
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Address Line | 5701 W 119TH ST STE 410
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City | OVERLAND PARK
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State | KS
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Zip | 66209-3721
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Country | US
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Telephone | 913-345-6901
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Fax | 913-469-4095
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 04-30708
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 04-30708
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License Number State | KS
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