Provider Demographics
NPI:1033101316
Name:ANGELL, DARA M (PA-C)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:M
Last Name:ANGELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 101ST TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-3366
Mailing Address - Country:US
Mailing Address - Phone:913-945-9660
Mailing Address - Fax:913-945-9659
Practice Address - Street 1:1000 E 101ST TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-3366
Practice Address - Country:US
Practice Address - Phone:913-945-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002030203363A00000X
KS1501149363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
O49C217Medicare UPIN
0490000Medicare ID - Type Unspecified