Individual
KATHLEEN D MAMMEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN FNP BC
Contact information
Practice address
825 EUCLID AVE, KANSAS CITY, MO 64124-2323
(816) 889-4614
(816) 889-4847
Mailing address
825 EUCLID AVE, KANSAS CITY, MO 64124-2323
(816) 889-4614
(816) 889-4847
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2005017142
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3046869 00
—
FL
05
—
421441304
—
MO
01
—
C16E724
MEDICARE B WHEATLANDS
MO
Enumeration date
07/21/2006
Last updated
01/16/2014
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