Provider Demographics
NPI:1568009488
Name:QUESENBERRY, MALLORY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:ELIZABETH
Last Name:QUESENBERRY
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:5501 NW 62ND TER STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2412
Mailing Address - Country:US
Mailing Address - Phone:816-842-4440
Mailing Address - Fax:816-842-1974
Practice Address - Street 1:3601 NE RALPH POWELL RD STE C
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2316
Practice Address - Country:US
Practice Address - Phone:816-285-5053
Practice Address - Fax:816-842-1974
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2022-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2020001927363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant