Provider Demographics
NPI:1437411725
Name:DOWELL, PHAEDRA M (MD)
Entity Type:Individual
Prefix:DR
First Name:PHAEDRA
Middle Name:M
Last Name:DOWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12140 NALL AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2507
Mailing Address - Country:US
Mailing Address - Phone:913-661-9448
Mailing Address - Fax:913-661-4688
Practice Address - Street 1:12140 NALL AVE STE 230
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2507
Practice Address - Country:US
Practice Address - Phone:913-661-9448
Practice Address - Fax:913-661-4688
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94079392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology