Provider Demographics
NPI:1255390613
Name:SIPES, PAMELA LYNN (ARNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:SIPES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:P
Other - Middle Name:LYNN
Other - Last Name:SIPES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:8901 W 74TH ST STE 380
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2245
Mailing Address - Country:US
Mailing Address - Phone:913-632-9870
Mailing Address - Fax:913-632-9898
Practice Address - Street 1:8901 W 74TH ST STE 380
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2245
Practice Address - Country:US
Practice Address - Phone:913-632-9870
Practice Address - Fax:913-632-9898
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45752363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00286008OtherRAILROAD MEDICARE
KS161599OtherBCBS KANSAS
KS200365380AMedicaid
KSP00286008OtherRAILROAD MEDICARE