Healthcare Provider Details

I. General information

NPI: 1083171292
Provider Name (Legal Business Name): ABBIE MAE OBRIEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2019
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17525 MEDICAL CENTER PKWY
INDEPENDENCE MO
64057-1824
US

IV. Provider business mailing address

8551 BLUEJACKET ST
LENEXA KS
66214-1656
US

V. Phone/Fax

Practice location:
  • Phone: 816-994-3150
  • Fax: 816-359-3044
Mailing address:
  • Phone: 913-981-1215
  • Fax: 913-439-4823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2019003331
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: