Individual
KELLI JO ANDRESEN
Active
Individual
KELLI JO ANDRESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2008002389
MO
2085R0202X
Diagnostic Radiology Physician
36297
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0472795
—
IA
05
—
1073597514
—
MO
05
—
200564680A
—
KS
01
—
37843017
BCBS KANSAS CITY
MO
01
—
37843027
BCBS KC GRP# 18959016
MO
01
—
39890
WELLMARK BCBS
IA
01
—
P00475714
RAILROAD MEDICARE
MO
Enumeration date
11/29/2005
Last updated
12/01/2017
Update your record
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