Provider Demographics
NPI:1922113307
Name:SNOW, CAMMILA RAE (PA)
Entity Type:Individual
Prefix:
First Name:CAMMILA
Middle Name:RAE
Last Name:SNOW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 S ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-3530
Mailing Address - Country:US
Mailing Address - Phone:816-838-2264
Mailing Address - Fax:
Practice Address - Street 1:12200 W 106TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2300
Practice Address - Country:US
Practice Address - Phone:913-327-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant