Provider Demographics
NPI:1487813291
Name:MINER, KATHRYN S (DO)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:MINER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 WORNALL RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3220
Mailing Address - Country:US
Mailing Address - Phone:816-932-5871
Mailing Address - Fax:
Practice Address - Street 1:9229 WARD PKWY STE 380
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-5471
Practice Address - Country:US
Practice Address - Phone:816-319-4785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100015032207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAR-8346OtherIOWA RESIDENT PHYSICIAN LICENSE NUMBER
MO2010015032OtherMO STATE LICENSE