Individual
MS. COURTNEY L DEKLOTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2401 GILLHAM RD, EMERGENCY MEDICINE, KANSAS CITY, MO 64108
(816) 234-8162
(816) 234-3421
Mailing address
2401 GILLHAM RD., PROVIDER ENROLLMENT, KANSAS CITY, MO 64108-4619
(816) 701-5200
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2018027302
MO
363LF0000X
Family Nurse Practitioner
78325
KS
Other
Enumeration date
05/29/2018
Last updated
08/16/2018
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