Provider Demographics
NPI:1952343238
Name:MATTHEWS, PAMELA (PAC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:MAGUET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4860 COLLEGE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1681
Mailing Address - Country:US
Mailing Address - Phone:816-478-4200
Mailing Address - Fax:816-875-2597
Practice Address - Street 1:4801 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1628
Practice Address - Country:US
Practice Address - Phone:816-478-4200
Practice Address - Fax:816-875-2597
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA688363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95001814Medicaid
KY95001814Medicaid
P45228Medicare UPIN
576418Medicare ID - Type Unspecified