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Individual

KELLY J HENDRICKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5701 W 119TH ST STE 410, OVERLAND PARK, KS 66209-3721
(913) 345-6901
(913) 469-4095
Mailing address
5701 W 119TH ST STE 410, OVERLAND PARK, KS 66209-3721
(913) 345-6901
(913) 469-4095

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
04-30708
KS
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
04-30708
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200265840A
KS
05
209281302
MO
01
34266011
BCBS
MO
01
580580
FIRSTGUARD
KS
01
P00154501
RAILROAD MEDICARE
Enumeration date
08/30/2006
Last updated
01/27/2022
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