Provider Demographics
NPI:1881648178
Name:WESTERN, PAMELA IRENE (CPNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:IRENE
Last Name:WESTERN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8541 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-1731
Mailing Address - Country:US
Mailing Address - Phone:913-831-9260
Mailing Address - Fax:
Practice Address - Street 1:4605 PASEO BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-1861
Practice Address - Country:US
Practice Address - Phone:816-234-3050
Practice Address - Fax:816-234-3836
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO056560363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
269B654Medicare ID - Type Unspecified
P53048Medicare UPIN