Provider Demographics
NPI:1225783780
Name:MCINTOSH, KALANIE RAE
Entity Type:Individual
Prefix:
First Name:KALANIE
Middle Name:RAE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 N LEONARD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2571
Mailing Address - Country:US
Mailing Address - Phone:816-248-2079
Mailing Address - Fax:
Practice Address - Street 1:1601 FRANKIE LN
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64503-3338
Practice Address - Country:US
Practice Address - Phone:816-617-6178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider