Provider Demographics
NPI:1669513156
Name:ANTHONY, ANDREA KRISTINE (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:KRISTINE
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 605
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3276
Mailing Address - Country:US
Mailing Address - Phone:816-691-5098
Mailing Address - Fax:816-346-7401
Practice Address - Street 1:2790 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 605
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3276
Practice Address - Country:US
Practice Address - Phone:816-691-5098
Practice Address - Fax:816-346-7401
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-3098207RC0200X
KS04-30908207RP1001X
MO2007028757207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1669513156Medicaid
MOMA4636003Medicare UPIN