Provider Demographics
NPI:1225554926
Name:TAYLOR, PAMELA (PHD)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 E BANNISTER RD STE F
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-3019
Mailing Address - Country:US
Mailing Address - Phone:816-569-3110
Mailing Address - Fax:
Practice Address - Street 1:402 E BANNISTER RD STE F
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-3019
Practice Address - Country:US
Practice Address - Phone:816-569-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO46-2425876OtherTRICARE EXTENDED HEALTH CARE OPTION