Provider Demographics
NPI:1578693024
Name:MUTHYALA, NEENA M (PA)
Entity Type:Individual
Prefix:MRS
First Name:NEENA
Middle Name:M
Last Name:MUTHYALA
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:4025 W 84TH ST
Mailing Address - Street 2:APARTMENT D
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-1902
Mailing Address - Country:US
Mailing Address - Phone:913-548-0191
Mailing Address - Fax:
Practice Address - Street 1:3801 BLUE PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130-2807
Practice Address - Country:US
Practice Address - Phone:816-922-5800
Practice Address - Fax:816-922-3179
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2007005064363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical