Basic Information
Provider Information | |||||||||
NPI: | 1962930156 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCKINNEY | ||||||||
FirstName: | SHARMA | ||||||||
MiddleName: | CATHERINE PROSSER | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4945 ALDEN ST | ||||||||
Address2: |   | ||||||||
City: | SHAWNEE | ||||||||
State: | KS | ||||||||
PostalCode: | 662165164 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9137098754 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 13351 S ARAPAHO DRIVE | ||||||||
Address2: | COTTONWOOD SPRINGS | ||||||||
City: | OLATHE | ||||||||
State: | KS | ||||||||
PostalCode: | 66062 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9133533000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/01/2017 | ||||||||
LastUpdateDate: | 06/01/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | F04170291 | KS | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.