Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Nov 8, 2018
License(s)
2018040346 (MO), 15-02209 (KS), PA62385 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 10109 W 93RD ST | Overland Park, KS 66212-4912 | 773-690-9542 |
| LOCATION | 4000 CAMBRIDGE ST | Kansas City, KS 66160-8501 | 913-588-1227 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.