Provider Demographics
NPI:1003843327
Name:MATTHEWS, KIMBERLY DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DIANE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9119 W 74TH ST
Mailing Address - Street 2:STE 300
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2236
Mailing Address - Country:US
Mailing Address - Phone:913-677-3113
Mailing Address - Fax:913-677-4514
Practice Address - Street 1:9119 W 74TH ST
Practice Address - Street 2:STE 300
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2236
Practice Address - Country:US
Practice Address - Phone:913-677-3113
Practice Address - Fax:913-677-4514
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-32836207V00000X
MO2007006298207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200452860BMedicaid
CS0974OtherRAILROAD MEDICARE
39117034OtherBLUE CROSS BLUE SHIELD OF KC
KS200452860BMedicaid