Basic Information
| Provider Information | |||||||||
| NPI: | 1215957584 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLEMING | ||||||||
| FirstName: | KANDICE | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 NW STATE ROUTE 7 STE B | ||||||||
| Address2: | |||||||||
| City: | BLUE SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640142426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162298187 | ||||||||
| FaxNumber: | 8162290376 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 NW STATE ROUTE 7 STE B | ||||||||
| Address2: | |||||||||
| City: | BLUE SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640142426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162298187 | ||||||||
| FaxNumber: | 8162290376 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 02/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2000160491 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 205963101 | 05 | MO | MEDICAID | 7407472 | 01 | AETNA | OTHER | 31516018 | 01 | BLUE CROSS BLUE SHIELD | OTHER |