Provider Demographics
NPI:1164781035
Name:KLINE, CARLYN MOLSTAD
Entity Type:Individual
Prefix:DR
First Name:CARLYN
Middle Name:MOLSTAD
Last Name:KLINE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CARLYN
Other - Middle Name:
Other - Last Name:MOLSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 STONECREST
Mailing Address - Street 2:
Mailing Address - City:ST. JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3126
Mailing Address - Country:US
Mailing Address - Phone:816-233-5459
Mailing Address - Fax:
Practice Address - Street 1:17 STONECREST
Practice Address - Street 2:
Practice Address - City:ST. JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3126
Practice Address - Country:US
Practice Address - Phone:816-233-5459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2448207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine