Provider Demographics
NPI:1710488143
Name:KOMOROSKI, KAREN (PHD, APRN, ANP-BC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:KOMOROSKI
Suffix:
Gender:F
Credentials:PHD, APRN, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 WESTPORT RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3128
Mailing Address - Country:US
Mailing Address - Phone:816-726-4074
Mailing Address - Fax:
Practice Address - Street 1:624 WESTPORT RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3128
Practice Address - Country:US
Practice Address - Phone:816-726-4074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016019549363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2016019549OtherMO APRN