Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 04-32836 | KS |
N | 207V00000X | Obstetrician & Gynecologist | 2007006298 | MO |
NPI | 1003843327 |
---|---|
Provider Name | Dr. Kimberly Diane Matthews |
First Address | Shawnee Mission, KS 66204-2236 |
Second Address | Shawnee Mission, KS 66204-2236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 15/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200452860B | (05) | KS |
39117034 | BLUE CROSS BLUE SHIELD OF KC (01) | |
CS0974 | RAILROAD MEDICARE (01) |