Basic Information
| Provider Information | |||||||||
| NPI: | 1669824470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEENAN | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4200 LITTLE BLUE PKWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640578312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163532700 | ||||||||
| FaxNumber: | 8167957311 | ||||||||
| Practice Location | |||||||||
| Address1: | 1930 N BUSINESS ROUTE 5 UNIT 1A | ||||||||
| Address2: | |||||||||
| City: | CAMDENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 650202659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733465624 | ||||||||
| FaxNumber: | 5733461957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2016 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/20/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2016022501 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | MO | MEDICAID |