Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RR0500X | Rheumatology | 05-36624 | KS |
Y | 207RR0500X | Rheumatology | 2015001548 | MO |
NPI | 1043440944 |
---|---|
Provider Name | Kalista Trombley Engelman |
First Address | Kansas City, MO 64111-3315 |
Second Address | Kansas City, MO 64111-3315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2009 |
Last Update Date | 15/03/2021 |