Provider Demographics
NPI:1417441452
Name:KRAHN, MALLORY (MD)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:
Last Name:KRAHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 CLAY EDWARDS DR STE 500
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3263
Mailing Address - Country:US
Mailing Address - Phone:816-421-4115
Mailing Address - Fax:816-421-4152
Practice Address - Street 1:2700 CLAY EDWARDS DR STE 500
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3263
Practice Address - Country:US
Practice Address - Phone:816-421-4115
Practice Address - Fax:816-421-4152
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-11165208000000X
MO2021020043208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics