Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 2010013492 | MO |
NPI | 1811102692 |
---|---|
Provider Name | Dr. Krystal Anne Keup |
First Address | Kansas City, MO 64114-3337 |
Second Address | Kansas City, MO 64145-1117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 23/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04-34429 | STATE LICENSE (01) | KS |
2010013492 | STATE LICENSE (01) | MO |