Provider Demographics
NPI:1235170424
Name:JANSEN-KRALY, KATHLEEN ELIZABETH (CNPN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:JANSEN-KRALY
Suffix:
Gender:F
Credentials:CNPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 E 63RD ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-1612
Mailing Address - Country:US
Mailing Address - Phone:816-361-1784
Mailing Address - Fax:
Practice Address - Street 1:16 E 63RD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-1612
Practice Address - Country:US
Practice Address - Phone:816-361-1784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO079824363LP0200X
KS45545363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO079824Medicaid
MO269B635Medicare ID - Type UnspecifiedMEDICARE ASSIGNED NUMBER
MO079824Medicaid