Provider Demographics
NPI:1598881468
Name:FELLOWS, KERRI LYNN (MD)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:LYNN
Last Name:FELLOWS
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 1:16538 W 159TH TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3924
Mailing Address - Country:US
Mailing Address - Phone:913-829-1660
Mailing Address - Fax:913-829-1770
Practice Address - Street 1:16538 W 159TH TER
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-3924
Practice Address - Country:US
Practice Address - Phone:913-819-1660
Practice Address - Fax:913-829-1770
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-06466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS033D00009Medicare PIN