Provider Demographics
NPI:1063440303
Name:MCBRATNEY, KATHLEEN RAE (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:RAE
Last Name:MCBRATNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 PROGRESS DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-5323
Mailing Address - Country:US
Mailing Address - Phone:913-651-3111
Mailing Address - Fax:913-651-3103
Practice Address - Street 1:1004 PROGRESS DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-5323
Practice Address - Country:US
Practice Address - Phone:913-651-3111
Practice Address - Fax:913-651-3103
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-20753174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS632670OtherMCB FIRSTGUARD
KS2005349OtherMCB AETNA
KS052082OtherMCB BCBS INV PROV #
KS12310032OtherMCB BCBS KC
KS052082OtherMCB BCBS INV PROV #
KS12310032OtherMCB BCBS KC
KS052082Medicare ID - Type UnspecifiedMCB INV PROV #