Individual
KELLY LYNN OVERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2301 HOLMES ST, KANSAS CITY, MO 64108-2640
(816) 404-0690
Mailing address
2301 HOLMES ST, KANSAS CITY, MO 64108-2640
(816) 404-0690
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
9406983
KS
2085R0202X
Diagnostic Radiology Physician
04-36422
KS
2085R0202X
Diagnostic Radiology Physician
Primary
2018024910
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200059650
—
MO
05
—
201094350A
—
KS
Enumeration date
07/03/2008
Last updated
12/01/2020
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