Provider Demographics
NPI:1972912152
Name:LABETH, CALLIE (NP)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:LABETH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:
Other - Last Name:GAMMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1004 CARONDELET DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4801
Mailing Address - Country:US
Mailing Address - Phone:816-389-6100
Mailing Address - Fax:816-389-6150
Practice Address - Street 1:1004 CARONDELET DR
Practice Address - Street 2:SUITE 410
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4801
Practice Address - Country:US
Practice Address - Phone:816-389-6100
Practice Address - Fax:816-389-6150
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014027719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily