Provider Demographics
NPI:1093940157
Name:VAN RY, KIRSTIE SCHNEIDER (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTIE
Middle Name:SCHNEIDER
Last Name:VAN RY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIRSTIE
Other - Middle Name:
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 219672
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9672
Mailing Address - Country:US
Mailing Address - Phone:816-781-7200
Mailing Address - Fax:816-781-6973
Practice Address - Street 1:2521 GLENN HENDREN DR
Practice Address - Street 2:STE 108
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3388
Practice Address - Country:US
Practice Address - Phone:816-781-7200
Practice Address - Fax:816-781-6973
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015020980208600000X
NC2014-00342208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1093940157Medicaid
SCNC2154Medicaid
NCNCJ451AMedicare PIN
NCNCJ451BMedicare PIN