Individual
MS. KELLY R GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN ARNP CRNA
Contact information
Practice address
1318 E 104TH ST, KANSAS CITY, MO 64131-4504
(816) 256-5200
Mailing address
29800 W 127TH ST, OLATHE, KS 66061-8636
(913) 522-0889
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
115622
MO
163W00000X
Registered Nurse
1358880051
KS
367500000X
Certified Registered Nurse Anesthetist
115622
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
54723
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00S23683
PREFERRED HEALTH SYSTEMS
KS
01
—
100016620001
COMMUNITY HEALTH PLAN
—
05
—
100403160D
—
KS
01
—
145353
BLUE CROSS BLUE SHIELD KS
KS
01
—
28034048
BLUE CROSS BLUE SHIELD KC
MO
01
—
5718942
FIRST HEALTH
—
01
—
66048A019
TRICARE WPS
KS
05
—
915400618
—
MO
01
—
P00365458
RAILROAD MEDICARE
MO
01
—
P00401683
RAILROAD MEDICARE
KS
Enumeration date
11/28/2005
Last updated
05/01/2025
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