Provider Demographics
NPI:1821040924
Name:MCKARNIN, CASSANDRA MARYA (DO)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MARYA
Last Name:MCKARNIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12541 FOSTER ST STE 300
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2304
Mailing Address - Country:US
Mailing Address - Phone:913-317-3200
Mailing Address - Fax:913-317-3218
Practice Address - Street 1:12541 FOSTER ST STE 300
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2304
Practice Address - Country:US
Practice Address - Phone:913-317-3200
Practice Address - Fax:913-317-3218
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0528546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H25686Medicare UPIN
KSG93000021Medicare PIN
H25686Medicare UPIN