Provider Demographics
NPI:1427513878
Name:REILLY, KIRSTEN ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:ANNE
Last Name:REILLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIRSTEN
Other - Middle Name:ANNE
Other - Last Name:KSARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8703 PINE ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66220-3366
Mailing Address - Country:US
Mailing Address - Phone:913-710-1056
Mailing Address - Fax:
Practice Address - Street 1:7900 LEE'S SUMMIT ROAD
Practice Address - Street 2:DEPARTMENT OF COMMUNITY AND FAMILY MEDICINE
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64139
Practice Address - Country:US
Practice Address - Phone:816-404-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104308208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics