Provider Demographics
NPI:1124186655
Name:SHANKLIN, PATRICIA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:SHANKLIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CHRIS
Other - Middle Name:A
Other - Last Name:SHANKLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1010 CARONDELET
Mailing Address - Street 2:BLDG A SUITE 412
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114
Mailing Address - Country:US
Mailing Address - Phone:816-942-9050
Mailing Address - Fax:816-942-9002
Practice Address - Street 1:1010 CARONDELET
Practice Address - Street 2:BLDG A SUITE 412
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114
Practice Address - Country:US
Practice Address - Phone:816-942-9050
Practice Address - Fax:816-942-9002
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPTMO01568103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
23866010OtherBLUE CROSS BLUE SHIELD
MOB882883Medicare ID - Type Unspecified