Provider Demographics
NPI:1952321580
Name:HARRIS, PAMELA SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:SUE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:SUE
Other - Last Name:FITZPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9001 STATE LINE RD # 300
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-3232
Mailing Address - Country:US
Mailing Address - Phone:816-363-2600
Mailing Address - Fax:816-523-0068
Practice Address - Street 1:9001 STATE LINE RD # 300
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3232
Practice Address - Country:US
Practice Address - Phone:816-363-2600
Practice Address - Fax:816-523-0068
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-228122081H0002X
MO1003072081H0002X, 2081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F26746Medicare UPIN