MEDICARE: DR. KRYSTAL ANNE KEUP 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	2010013492	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04-34429	OTHER	KS	STATE LICENSE
2	2010013492	OTHER	MO	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811102692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRYSTAL ANNE KEUP M.D.

Provider Business Mailing Address
First Line	:	9221 WARD PARKWAY
Second Line	:	STE. 1000
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-3337
Country	:	US
Telephone Number	:	816-363-2600
Fax Number	:	816-523-0068

Provider Business Practice Location Address
First Line	:	12000 WORNALL ROAD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64145-1117
Country	:	US
Telephone Number	:	816-941-1000
Fax Number	:	816-941-1500

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/23/2010

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