Provider Demographics
NPI:1033148507
Name:GLYNN, KERSTIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KERSTIN
Middle Name:M
Last Name:GLYNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KERSTIN
Other - Middle Name:M
Other - Last Name:BOHATY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SABETHA
Mailing Address - State:KS
Mailing Address - Zip Code:66534-2801
Mailing Address - Country:US
Mailing Address - Phone:785-285-0921
Mailing Address - Fax:
Practice Address - Street 1:1412 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002
Practice Address - Country:US
Practice Address - Phone:913-367-4879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29719207Q00000X
KS0429719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100423990BMedicaid
KS100423990AMedicaid
102177Medicare PIN