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ADULT AND PEDIATRIC DERMATOLOGY NPI 1609966753


NPI Information

NPI: 1609966753
Provider Name: ADULT AND PEDIATRIC DERMATOLOGY
Classification: Dermatology - 207N00000X
Entity Type: Organization

CLIA Number: 17D0687168

Address:
4601 W 109TH ST STE 116
OVERLAND PARK, KS
ZIP 66211
Phone: (913) 469-1115
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ADULT AND PEDIATRIC DERMATOLOGY is a dermatology in Overland Park, KS. The provider is a dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. ADULT AND PEDIATRIC DERMATOLOGY NPI is 1609966753. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4601 W 109TH ST STE 116
OVERLAND PARK, KS
ZIP 66211-313
Phone: (913) 469-1115
Fax: (913) 469-9192

The provider's authorized official is Jenean C Kemp .
The authorized official title is Administrator and has the following contact phone number (913) 948-9184.

The CLIA number assigned to this NPI record is 17D0687168 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 10/12/2006 and was last updated on 7/13/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207N00000XDermatology0422209KANSASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1CI3423OTHERKANSASMEDICARE RAILROAD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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