Provider Demographics
NPI:1427091776
Name:HEDGES, KATHRYN A (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:HEDGES
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 1:2000 SE BLUE PKWY
Mailing Address - Street 2:SUITE 270-A
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-1041
Mailing Address - Country:US
Mailing Address - Phone:816-524-1700
Mailing Address - Fax:816-524-1794
Practice Address - Street 1:2000 SE BLUE PKWY
Practice Address - Street 2:SUITE 270-A
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-1041
Practice Address - Country:US
Practice Address - Phone:816-524-1700
Practice Address - Fax:816-524-1794
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1003092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1427091776Medicaid
KS100136020DMedicaid
MOP00467494Medicare PIN
E85497Medicare UPIN
MOX111718Medicare PIN
KS100136020DMedicaid