Provider Demographics
NPI:1669647871
Name:WISE, KIMBERLY ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANNE
Last Name:WISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:WISE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2106 OLATHE BLVD MAILSTOP 4004
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-6300
Mailing Address - Fax:913-274-3515
Practice Address - Street 1:7301 MISSION RD STE 350
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3075
Practice Address - Country:US
Practice Address - Phone:913-588-6300
Practice Address - Fax:913-274-3515
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC148910208000000X
KS442197208000000X
GA65701208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics