Provider Demographics
NPI:1538162037
Name:BEATHAM, KAREN ANN (DO)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANN
Last Name:BEATHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:PENKSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1206 SE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-3304
Mailing Address - Country:US
Mailing Address - Phone:816-525-6941
Mailing Address - Fax:
Practice Address - Street 1:5308 E 115TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-2731
Practice Address - Country:US
Practice Address - Phone:816-763-9165
Practice Address - Fax:816-763-9208
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1H88207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO24247800Medicaid
MOG637009Medicare ID - Type Unspecified
MOE10508Medicare UPIN