17D1103338 CLIA NUMBER - ANNE KETTLER MD COLLEGE PARK FAMILY CARE

Laboratory Demographics

  • CLIA Code: 17D1103338
  • Facility Name: ANNE KETTLER MD COLLEGE PARK FAMILY CARE
  • Facility Address: 15101 GLENWOOD
    OVERLAND PARK, KS
    ZIP 66223
  • Facility Phone: 913 681-8866
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. ANNE H. KETTLER
  • NPI Number: 1659368967
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 17D1103338
LAB Type Physician Office
Facility Name ANNE KETTLER MD COLLEGE PARK FAMILY CARE
Street 15101 GLENWOOD
City OVERLAND PARK
State KS
ZIP 66223
Phone 913 681-8866
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 7/4/2025
Certificate Expiration Date 7/3/2027
Facility Type Physician Office
Lab Director DR. ANNE H. KETTLER

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This page was last updated on: 9/29/2025