Provider Demographics
NPI:1619170560
Name:KILLINGSWORTH, MARTHA L (ARNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:KILLINGSWORTH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10600 QUIVIRA RD
Mailing Address - Street 2:KANSAS CITY WOMENS CLINIC 3RD FLOOR
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2309
Mailing Address - Country:US
Mailing Address - Phone:913-894-8500
Mailing Address - Fax:913-492-2874
Practice Address - Street 1:10600 QUIVIRA RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2309
Practice Address - Country:US
Practice Address - Phone:913-894-8500
Practice Address - Fax:913-492-2874
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS14-84213-082363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS168B852Medicare ID - Type Unspecified
KSP61326Medicare UPIN