Provider Demographics
NPI:1710958590
Name:KLINGENSMITH, JUDITH A (ARNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:KLINGENSMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-2477
Mailing Address - Country:US
Mailing Address - Phone:816-765-8900
Mailing Address - Fax:816-763-9359
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030
Practice Address - Country:US
Practice Address - Phone:816-765-8900
Practice Address - Fax:816-763-9359
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO083330363LF0000X, 363L00000X
KS44725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS44725OtherKANSAS LICENSE
KS44725OtherKANSAS LICENSE
MOMA1521003Medicare PIN
KS44725OtherKANSAS LICENSE
MOX93000046Medicare PIN