Provider Demographics
NPI:1366481566
Name:KELLY, KATHERINE PATTERSON (RN, MCCNS)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:PATTERSON
Last Name:KELLY
Suffix:
Gender:F
Credentials:RN, MCCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 NE ASH GROVE DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1303
Mailing Address - Country:US
Mailing Address - Phone:816-478-4084
Mailing Address - Fax:
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-3080
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO093855163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO093855OtherNURSING LICENSE
MO093855OtherNURSING LICENSE
MOS72452Medicare UPIN