Provider Demographics
NPI:1841229200
Name:TWENTER, KATHRYN CLARE (DO)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CLARE
Last Name:TWENTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:CLARE
Other - Last Name:VANDENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 875743
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64187-5743
Mailing Address - Country:US
Mailing Address - Phone:913-215-5008
Mailing Address - Fax:816-524-4798
Practice Address - Street 1:3066 SW GRANDSTAND CIR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-3866
Practice Address - Country:US
Practice Address - Phone:913-215-5008
Practice Address - Fax:816-524-4798
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006019899207R00000X, 207RG0300X, 208M00000X
KS05-32072207R00000X, 207RG0300X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200407770AMedicaid
MO200876001Medicaid
KS200407770AMedicaid
MO200876001Medicaid