Provider Demographics
NPI:1437166287
Name:CARNEY, PAMELA ANNE (PT)
Entity Type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:ANNE
Last Name:CARNEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18315 MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66218-9024
Mailing Address - Country:US
Mailing Address - Phone:913-631-5749
Mailing Address - Fax:913-962-0355
Practice Address - Street 1:7510 STATE LINE RD
Practice Address - Street 2:STE A
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3615
Practice Address - Country:US
Practice Address - Phone:913-631-5749
Practice Address - Fax:913-962-0355
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1102764225100000X
MO2000162373225100000X
COPTL0003753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1324290OtherCIGNA
KS26240024OtherBCBS
KS544A00001Medicare PIN