Basic Information
Provider Information
NPI: 1003801085
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOUSTON-GRAY
FirstName: KARLA
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2340 E MEYER BLVD STE 640
Address2:  
City: KANSAS CITY
State: MO
PostalCode: 641321110
CountryCode: US
TelephoneNumber: 8165237000
FaxNumber: 8165237095
Practice Location
Address1: 2340 E MEYER BLVD STE 640
Address2:  
City: KANSAS CITY
State: MO
PostalCode: 641321110
CountryCode: US
TelephoneNumber: 8165237000
FaxNumber: 8165237095
Other Information
ProviderEnumerationDate: 09/15/2005
LastUpdateDate: 04/05/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD 109234MOY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
100454720A05KS MEDICAID
20807931905MO MEDICAID


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