Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | R2448 | MO |
NPI | 1164781035 |
---|---|
Provider Name | Dr. Carlyn Molstad Kline |
First Address | St. Joseph, MO 64506-3126 |
Second Address | St. Joseph, MO 64506-3126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2012 |
Last Update Date | 11/05/2012 |