Individual
KELLY ANDRA
Active
Individual
KELLY ANDRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0438218
KS
207R00000X
Internal Medicine Physician
2007015074
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205481609
—
MO
Enumeration date
05/01/2007
Last updated
02/03/2017
Update your record
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