Provider Demographics
NPI:1215957584
Name:FLEMING, KANDICE L (MD)
Entity type:Individual
Prefix:
First Name:KANDICE
Middle Name:L
Last Name:FLEMING
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 1:725 NW STATE ROUTE 7 STE B
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2426
Mailing Address - Country:US
Mailing Address - Phone:816-229-8187
Mailing Address - Fax:816-229-0376
Practice Address - Street 1:725 NW STATE ROUTE 7 STE B
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2426
Practice Address - Country:US
Practice Address - Phone:816-229-8187
Practice Address - Fax:816-229-0376
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000160491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205963101Medicaid
7407472OtherAETNA
31516018OtherBLUE CROSS BLUE SHIELD
MOP00077628Medicare PIN
K44C092Medicare PIN
31516018OtherBLUE CROSS BLUE SHIELD