Provider Demographics
NPI:1336600642
Name:ATKISON, CHARLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARLEY
Middle Name:
Last Name:ATKISON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 CLAY EDWARDS DR STE 650
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3279
Mailing Address - Country:US
Mailing Address - Phone:816-459-7500
Mailing Address - Fax:816-459-9611
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 650
Practice Address - Street 2:
Practice Address - City:N KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3279
Practice Address - Country:US
Practice Address - Phone:816-459-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program