Provider Demographics
NPI:1982696134
Name:SKELSEY, KEVIN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ROBERT
Last Name:SKELSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:ROBERT
Other - Last Name:SKELSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2720 SW GRAY LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-4133
Mailing Address - Country:US
Mailing Address - Phone:816-765-3990
Mailing Address - Fax:816-246-2181
Practice Address - Street 1:1621 NW BLUE PKWY
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5708
Practice Address - Country:US
Practice Address - Phone:816-246-1111
Practice Address - Fax:816-246-3931
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004035463207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209445600Medicaid
MOM71D549Medicare ID - Type Unspecified