MEDICARE: DR. KENNETH ALLEN SPAULDING M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	283Q00000X	Psychiatric Hospital	36043	MO

General Provider Information

NPI Number	:	1285742460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH ALLEN SPAULDING M.D.

Provider Business Mailing Address
First Line	:	3719 LOCUST ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64109-2627
Country	:	US
Telephone Number	:	816-561-9283
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 RAYTOWN RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-2141
Country	:	US
Telephone Number	:	816-356-5688
Fax Number	:	816-382-6351

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	07/08/2007

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