Provider Demographics
NPI:1952457871
Name:FUNKHOUSER, MEREDITH ANN
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:ANN
Last Name:FUNKHOUSER
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 1:10817 HORTON ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1143
Mailing Address - Country:US
Mailing Address - Phone:913-645-9633
Mailing Address - Fax:913-649-1467
Practice Address - Street 1:10817 HORTON ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1143
Practice Address - Country:US
Practice Address - Phone:913-645-9633
Practice Address - Fax:913-649-1467
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator