Basic Information
| Provider Information | |||||||||
| NPI: | 1598080426 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILLENWATER | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | STONEBRAKER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 CAMBRIDGE 6040 DELP MS 1020 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135885165 | ||||||||
| FaxNumber: | 9135883877 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 CAMBRIDGE 6040 DELP MS 1020 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135885165 | ||||||||
| FaxNumber: | 9135883877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2010 | ||||||||
| LastUpdateDate: | 07/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2013020396 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 05-41063 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.