OrganizationActive
Adult and Pediatric Dermatology
NPI 1609966753 · Dermatology Physician · Overland Park, KS
Provider details
- NPI number
- 1609966753
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jenean Kemp, Administrator(913) 948-9184
- License
- 0422209 (KS)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
4601 W 109th St Ste 116
Overland Park, KS 66211-1313
Phone: (913) 469-1115
Fax: (913) 469-9192
Approximate (ZIP-level) locationGet directions
Mailing address
4601 W. 109th Street
Overland Park, KS 66211-1313
Registry dates
- Enumerated
- 2006-10-12
- Last updated
- 2022-07-13
- Certified
- 2022-07-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.