Provider Demographics
NPI:1952518706
Name:GENTRY, GERALD K (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:K
Last Name:GENTRY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5408
Mailing Address - Country:US
Mailing Address - Phone:816-374-3838
Mailing Address - Fax:913-782-4214
Practice Address - Street 1:302 E PARK ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5408
Practice Address - Country:US
Practice Address - Phone:816-374-3838
Practice Address - Fax:913-782-4214
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP508103T00000X
MOR0070 (INACTIVE)103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS119836OtherBC-BS OF KANSAS
KS08364020OtherBC-BS OF KANSAS CITY
KS119836OtherBC-BS OF KANSAS