Provider Demographics
NPI:1952306516
Name:GAGE, KAREN R
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:R
Last Name:GAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9102 W 119TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1571
Mailing Address - Country:US
Mailing Address - Phone:913-406-1496
Mailing Address - Fax:
Practice Address - Street 1:9102 W 119TH TER
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1571
Practice Address - Country:US
Practice Address - Phone:913-406-1496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO152375363L00000X
KS45153363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS590B077AMedicare ID - Type Unspecified
MO590B077Medicare ID - Type Unspecified