Provider Demographics
NPI:1558492447
Name:KEPUS, PAMELA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:KEPUS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8765 N AMBASSADOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-2540
Mailing Address - Country:US
Mailing Address - Phone:913-297-7472
Mailing Address - Fax:816-382-3435
Practice Address - Street 1:8765 N AMBASSADOR DRIVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-2540
Practice Address - Country:US
Practice Address - Phone:913-297-7472
Practice Address - Fax:816-382-3435
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45337363LF0000X
MO107568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP26276Medicare UPIN