Provider Demographics
NPI:1891837134
Name:KAHMKE, REBECCA A (AHCNS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:KAHMKE
Suffix:
Gender:F
Credentials:AHCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:3525 S NATIONAL AVE STE 205A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7315
Practice Address - Country:US
Practice Address - Phone:417-269-9714
Practice Address - Fax:417-269-9236
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO149506364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1891837134Medicaid
MO431560263OtherTRICARE
MOP00209608OtherRR MCR
MO132680351Medicare PIN