Provider Demographics
NPI:1760711188
Name:SKINNER, KELLY K (FNP - C)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:K
Last Name:SKINNER
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Gender:F
Credentials:FNP - C
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Mailing Address - Street 1:19201 E VALLEY VIEW PKWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6910
Mailing Address - Country:US
Mailing Address - Phone:816-254-2552
Mailing Address - Fax:816-833-0398
Practice Address - Street 1:19201 E VALLEY VIEW PKWY
Practice Address - Street 2:SUITE G
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6910
Practice Address - Country:US
Practice Address - Phone:816-254-2552
Practice Address - Fax:816-833-0398
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2022-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2006022291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily