Healthcare Provider Details

I. General information

NPI: 1659433415
Provider Name (Legal Business Name): PAMELA C MCKENNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53-3925 AKONI PULE HWY
KAPAAU HI
96755
US

IV. Provider business mailing address

45-549 PLUMERIA ST
HONOKAA HI
96727-6902
US

V. Phone/Fax

Practice location:
  • Phone: 808-889-6236
  • Fax: 808-889-0107
Mailing address:
  • Phone: 808-775-7204
  • Fax: 808-775-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54673-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: