Provider Demographics
NPI:1750670600
Name:SPEER, KATHERINE KELSEY (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:KELSEY
Last Name:SPEER
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 1:21 N 12TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-5161
Mailing Address - Country:US
Mailing Address - Phone:913-342-2552
Mailing Address - Fax:
Practice Address - Street 1:21 N 12TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-5161
Practice Address - Country:US
Practice Address - Phone:913-342-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA300521208000000X
KS0439609208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program