Provider Demographics
NPI:1629187992
Name:SPROULES, KATHLEEN R (DO)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:R
Last Name:SPROULES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:R
Other - Last Name:WEATHERFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:9237 WARD PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-3365
Mailing Address - Country:US
Mailing Address - Phone:816-333-9200
Mailing Address - Fax:816-268-2601
Practice Address - Street 1:9237 WARD PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3365
Practice Address - Country:US
Practice Address - Phone:816-333-9200
Practice Address - Fax:816-268-2601
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8J23207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E81849Medicare UPIN