Individual
DEETRA YELENA FORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3901 RAINBOW BLVD, KANSAS CITY, KS 66160-8500
(913) 945-8700
Mailing address
3901 RAINBOW BLVD, KANSAS CITY, KS 66160-8500
(913) 945-8700
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
946742
KS
2084N0400X
Neurology Physician
Primary
2011021426
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023214129
—
MO
05
—
200743370A
—
KS
01
—
P00991358
RR MEDICARE
MO
Enumeration date
06/25/2007
Last updated
07/25/2014
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