Provider Demographics
NPI:1558399014
Name:ANDERSON, CATHERINE ALPHA (DO)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:ALPHA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4506 NW LAKOTA CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:MO
Mailing Address - Zip Code:64150-9787
Mailing Address - Country:US
Mailing Address - Phone:816-225-9358
Mailing Address - Fax:
Practice Address - Street 1:6651 N OAK TRFY STE 3
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-3353
Practice Address - Country:US
Practice Address - Phone:816-203-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010001784207Q00000X
KS05-34354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1558399014Medicaid
MO1785154388OtherCDS
KS200655910AMedicaid
MOFA1831759OtherDEA NUMBER
KSK15000024Medicare PIN
KSFA2009911OtherDEA NUMBER