Individual
KIMBERLY VANDERPAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1113 NE KENWOOD DR, LEES SUMMIT, MO 64064-1769
(816) 582-9939
Mailing address
1113 NE KENWOOD DR, LEES SUMMIT, MO 64064-1769
(816) 582-9939
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85
—
MO
Enumeration date
03/27/2007
Last updated
07/08/2007
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