Provider Demographics
NPI:1356496442
Name:KIEKHAEFER, RUTH A (PNP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:KIEKHAEFER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 N RIVERSIDE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2566
Mailing Address - Country:US
Mailing Address - Phone:816-271-1360
Mailing Address - Fax:816-271-1355
Practice Address - Street 1:902 N RIVERSIDE RD STE 100
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2566
Practice Address - Country:US
Practice Address - Phone:816-271-1360
Practice Address - Fax:816-271-1355
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO077613364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics