Provider Demographics
NPI:1821061250
Name:SISK, PAMELA L (APRN, BC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:SISK
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:L
Other - Last Name:ASHFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 NW SOUTH OUTER RD
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-3065
Mailing Address - Country:US
Mailing Address - Phone:816-286-0222
Mailing Address - Fax:
Practice Address - Street 1:1200 NW SOUTH OUTER RD
Practice Address - Street 2:STE 301
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3059
Practice Address - Country:US
Practice Address - Phone:816-795-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO131115163WP0808X, 363LP0808X, 163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO423952514Medicaid
MO8248835Medicare ID - Type Unspecified