Individual
RANDY KELLENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
800 RAVENHILL DR, EMERGENCY DEPARTMENT, ATCHISON, KS 66002-9204
(913) 360-5320
Mailing address
16410 RIGGS RD, STILWELL, KS 66085-9128
(913) 681-3217
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
R9G92
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
242720654
—
MO
Enumeration date
12/23/2005
Last updated
12/06/2016
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