1285671784 NPI number — KENNA K BELSHE DO

Table of content: KENNA K BELSHE DO (NPI 1285671784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285671784 NPI number — KENNA K BELSHE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELSHE
Provider First Name:
KENNA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADIGA
Provider Other First Name:
KENNA
Provider Other Middle Name:
KATHLEEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285671784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 CLAY EDWARDS DR
Provider Second Line Business Mailing Address:
SUITE 240
Provider Business Mailing Address City Name:
NORTH KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64116-3251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-455-0681
Provider Business Mailing Address Fax Number:
816-455-5294

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 CLAY EDWARDS DR
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
NORTH KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64116-3251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-455-0681
Provider Business Practice Location Address Fax Number:
816-455-5294
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  2004009977 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 2004009977 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1285671784 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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