Individual
KELLY B. PENDERGRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4881 NE GOODVIEW CIR, LEES SUMMIT, MO 64064-1996
(913) 574-2350
(913) 574-2413
Mailing address
9200 INDIAN CREEK PKWY, BUILDING 9, SUITE 300, OVERLAND PARK, KS 66210-2002
(913) 574-2800
(913) 574-2336
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
04-25043
KS
207RH0003X
Hematology & Oncology Physician
Primary
R6A95
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100364750B
—
KS
05
—
1639140221
—
MO
Enumeration date
01/31/2006
Last updated
04/17/2018
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