Provider Demographics
NPI:1659365005
Name:HUTTON ROTERT, KAREN LOUISE (RN, MSN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LOUISE
Last Name:HUTTON ROTERT
Suffix:
Gender:F
Credentials:RN, MSN, FNP-C
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:LOUISE
Other - Last Name:HUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11157
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-0157
Mailing Address - Country:US
Mailing Address - Phone:913-234-1350
Mailing Address - Fax:913-234-1108
Practice Address - Street 1:2800 CLAY EDWARDS DR
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3220
Practice Address - Country:US
Practice Address - Phone:816-346-7220
Practice Address - Fax:816-346-7242
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO079772163WE0003X
MO079722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00052730OtherRR MEDICARE GROUP CD1534
26241022OtherBCBS KC MO NON PAR ID #
MO424867216Medicaid
MO6781447Medicare PIN
S81045Medicare UPIN
MO424867216Medicaid