Provider Demographics
NPI:1982295309
Name:CASS, KIMBERLYNN GABRIELLE
Entity Type:Individual
Prefix:
First Name:KIMBERLYNN
Middle Name:GABRIELLE
Last Name:CASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLYNN
Other - Middle Name:GABRIELLE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2906 NW VIVION RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:MO
Mailing Address - Zip Code:64150-1502
Mailing Address - Country:US
Mailing Address - Phone:816-599-5050
Mailing Address - Fax:816-599-5961
Practice Address - Street 1:2411 HOLMES ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2741
Practice Address - Country:US
Practice Address - Phone:816-235-5412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02669363AM0700X
MO2022032222363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical