Basic Information
| Provider Information | |||||||||
| NPI: | 1528383486 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRINT | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 N. BELT HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | ST. JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 645062410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162717077 | ||||||||
| FaxNumber: | 8162710421 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 N. BELT HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | ST. JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 645062410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162717077 | ||||||||
| FaxNumber: | 8162710421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2010 | ||||||||
| LastUpdateDate: | 02/21/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2010009033 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 200641210A | 05 | KS | MEDICAID | P00859653 | 01 | MO | RR MEDICARE | OTHER | 1528383486 | 05 | MO | MEDICAID |