Individual
POONAM KHANNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
14221 METCALF AVE, SUITE 123, OVERLAND PARK, KS 66223-3344
(913) 912-7054
Mailing address
14221 METCALF AVE, SUITE 123, OVERLAND PARK, KS 66223-3344
(913) 912-7054
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
05-29535
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100421600A
—
KS
01
—
245887708
MO MEDICAID
MO
01
—
260050357
RR MEDICARE
—
01
—
31650014
BCBS KC
MO
Enumeration date
01/11/2007
Last updated
01/27/2012
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