Provider Demographics
NPI:1992111710
Name:FALK, KATELYN MARIE MERANDO (MD)
Entity type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:MARIE MERANDO
Last Name:FALK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KATELYN
Other - Middle Name:MARIE
Other - Last Name:MERANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 MT. CARMEL WAY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-2539
Mailing Address - Country:US
Mailing Address - Phone:620-231-6100
Mailing Address - Fax:
Practice Address - Street 1:1 MT CARMEL WAY
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-7587
Practice Address - Country:US
Practice Address - Phone:620-231-6100
Practice Address - Fax:620-231-7602
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014020085207Q00000X
KS04-39487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200692260AMedicaid
KS201149630AMedicaid