Pediatric Dermatology of Kansas City
Organization Active NPI Pediatric Dermatology Physician · Mission Woods, KS
NPI 1396211678 · NPPES record last updated Dec 7, 2023
Key facts
- NPI
- 1396211678
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatric Dermatology Physician 207NP0225X
- Legal business name
- PEDIATRIC DERMATOLOGY OF KANSAS CITY
- Practice address
- 2001 Shawnee Mission Pkwy
Mission Woods, KS 66205-2007 - Phone
- (913) 339-8188
- NPI assigned
- Oct 15, 2018
- Organization subpart
- No
Authorized official
- Name
- Sue Ann Douglas, MD
- Title
- Physician Owner
- Phone
- (913) 228-2000
Practitioners 3
-
Sue Ann Douglas, MD
-
Madison Faddis, DNP, FNP-C
-
Pamela Matthews, PAC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D2166613 | Pediatric Dermatology of Kansas City | Provider-performed microscopy | May 20, 2027 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dermatology Physician |
207NP0225X | Yes |
Addresses
Primary practice location
2001 Shawnee Mission Pkwy
Mission Woods, KS 66205-2007
Mailing address
2001 Shawnee Mission Pkwy Ste 130
Mission Woods, KS 66205-2060
Phone (913) 228-2000
Other providers in Mission Woods, KS
All providers in Mission Woods, KS · Pediatric Dermatology Physician in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.