Provider Demographics
NPI:1295997211
Name:WONG MCKINSTRY, EDNA (MD)
Entity type:Individual
Prefix:DR
First Name:EDNA
Middle Name:
Last Name:WONG MCKINSTRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EDNA
Other - Middle Name:SIEW LING
Other - Last Name:WONG MCKINSTRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:1125 MADISON ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-5227
Practice Address - Country:US
Practice Address - Phone:573-632-5000
Practice Address - Fax:573-634-2033
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036145058207R00000X
AZ44626207R00000X
TXQ2870207R00000X
IN01079554A207R00000X
MO2016009554207R00000X, 208M00000X
NC2016-01960207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ634059Medicaid
AZZ153557Medicare PIN