Organization
ADULT AND PEDIATRIC DERMATOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENEAN C KEMP (ADMINISTRATOR)
(913) 948-9184
Entity
Organization
Contact information
Practice address
4601 W 109TH ST STE 116, OVERLAND PARK, KS 66211-1313
(913) 469-1115
(913) 469-9192
Mailing address
4601 W. 109TH STREET, SUITE 116, OVERLAND PARK, KS 66211-1313
(913) 469-1115
(913) 469-9192
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0422209
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CI3423
MEDICARE RAILROAD
KS
Enumeration date
10/12/2006
Last updated
07/13/2022
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