Provider Demographics
NPI:1689623183
Name:WEYDERT, JOY A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:A
Last Name:WEYDERT
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 1:3901 RAINBOW BLVD
Mailing Address - Street 2:MAIL STOP 4004
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66103-2937
Mailing Address - Country:US
Mailing Address - Phone:913-588-6364
Mailing Address - Fax:913-588-6338
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MAIL STOP 4004
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-2937
Practice Address - Country:US
Practice Address - Phone:913-588-6364
Practice Address - Fax:913-588-6338
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002029455208000000X
KS04-34064208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100445690CMedicaid
MO205970106Medicaid
KS032A00011Medicare PIN
F87256Medicare UPIN
MO205970106Medicaid