Provider Demographics
NPI:1609832757
Name:WADE, KERRI RANDENE (APRN, BC, PNP)
Entity Type:Individual
Prefix:MS
First Name:KERRI
Middle Name:RANDENE
Last Name:WADE
Suffix:
Gender:F
Credentials:APRN, BC, PNP
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:RANDENE
Other - Last Name:NEGAARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-234-3581
Mailing Address - Fax:816-234-3589
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-3581
Practice Address - Fax:816-234-3589
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO092706363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100415200AMedicaid
MO425770708Medicaid
269B573Medicare ID - Type Unspecified
MO425770708Medicaid