Individual
KYLIE IMMETHUN GAUSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
6013 LEAVENWORTH RD, KANSAS CITY, KS 66104-1436
(913) 321-2200
Mailing address
3801 DR MARTIN LUTHER KING JR BLVD, KANSAS CITY, MO 64130-2807
(816) 923-5800
(816) 922-1070
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
53-76912-101
KS
Other
Enumeration date
09/08/2015
Last updated
04/24/2026
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