Provider Demographics
NPI:1134852460
Name:WILHELMUS, KATHLEEN MCKENZIE
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MCKENZIE
Last Name:WILHELMUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MCKENZIE
Other - Last Name:WILHELMUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:430 W 67TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-1947
Mailing Address - Country:US
Mailing Address - Phone:816-260-1922
Mailing Address - Fax:
Practice Address - Street 1:905 W FOXWOOD DR
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-7200
Practice Address - Country:US
Practice Address - Phone:816-322-1872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022022081152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist