Provider Demographics
NPI:1659433415
Name:MCKENNA, PAMELA C (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:C
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:45-549 PLUMERIA ST
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-6902
Mailing Address - Country:US
Mailing Address - Phone:808-775-7204
Mailing Address - Fax:808-775-9404
Practice Address - Street 1:53-3925 AKONI PULE HWY
Practice Address - Street 2:
Practice Address - City:KAPAAU
Practice Address - State:HI
Practice Address - Zip Code:96755
Practice Address - Country:US
Practice Address - Phone:808-889-6236
Practice Address - Fax:808-889-0107
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI54673-20208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD5231OtherSTATE LICENSE
WI1659433415Medicaid
HIE04682OtherCONTROLLED SUBSTANCES
HIE04682OtherCONTROLLED SUBSTANCES
HIAM2480325OtherDEA