Provider Demographics
NPI:1528381050
Name:SKRETTA, KELLY D (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:D
Last Name:SKRETTA
Suffix:
Gender:F
Credentials:NP
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 400
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3270
Mailing Address - Country:US
Mailing Address - Phone:164-214-2408
Mailing Address - Fax:816-421-5015
Practice Address - Street 1:2700 CLAY EDWARDS DR STE 400
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3270
Practice Address - Country:US
Practice Address - Phone:164-214-2408
Practice Address - Fax:816-421-5015
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010009589363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1528381050Medicaid
MO1528381050Medicaid