Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD 109234 | MO |
Y | 111NI0900X | Internist | MD 109234 | MO |
NPI | 1003801085 |
---|---|
Provider Name | Karla L Houston-Gray |
First Address | Kansas City, MO 64132-1110 |
Second Address | Kansas City, MO 64132-1110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 05/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100454720A | (05) | KS |
208079319 | (05) | MO |
G14006 | (02) | MO |