Provider Demographics
NPI:1528644317
Name:BOHAN, KRISTY R
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:R
Last Name:BOHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4551 PENNSYLVANIA AVE UNIT 1216
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3387
Mailing Address - Country:US
Mailing Address - Phone:256-701-2142
Mailing Address - Fax:
Practice Address - Street 1:10330 HICKMAN MILLS DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-1618
Practice Address - Country:US
Practice Address - Phone:816-501-5138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst