Basic Information
Provider Information
NPI: 1700854783
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BEATTY
FirstName: KAY
MiddleName: F
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: KARASEK
OtherFirstName: KAY
OtherMiddleName: F
OtherNamePrefix: DR.
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 5325 FARAON ST
Address2:  
City: SAINT JOSEPH
State: MO
PostalCode: 645063488
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 5325 FARAON ST
Address2:  
City: SAINT JOSEPH
State: MO
PostalCode: 645063488
CountryCode: US
TelephoneNumber: 8162716350
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/08/2006
LastUpdateDate: 04/12/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X105471MOY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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