=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225409634
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN MANN APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2015
-----------------------------------------------------
Last Update Date | 05/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3901 RAINBOW BLVD MS 3016
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-588-6152
-----------------------------------------------------
Fax | 913-588-0603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1962 W SURREY ST MS 3016
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66061-8846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-588-6152
-----------------------------------------------------
Fax | 913-588-0603
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 76943
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------