Provider Demographics
NPI:1528383486
Name:GRINT, KATHLEEN M (APN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:GRINT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 N. BELT HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:ST. JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2410
Mailing Address - Country:US
Mailing Address - Phone:816-271-7077
Mailing Address - Fax:816-271-0421
Practice Address - Street 1:1115 N. BELT HIGHWAY
Practice Address - Street 2:
Practice Address - City:ST. JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2410
Practice Address - Country:US
Practice Address - Phone:816-271-7077
Practice Address - Fax:816-271-0421
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010009033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200641210AMedicaid
MOP00859653OtherRR MEDICARE
MO1528383486Medicaid
MOP00859653OtherRR MEDICARE