Healthcare Provider Details

I. General information

NPI: 1194686162
Provider Name (Legal Business Name): AUDREY L PICKEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5844 NW BARRY RD STE 270
KANSAS CITY MO
64154-1466
US

IV. Provider business mailing address

901 E 104TH ST # MS 400S
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 913-491-9100
  • Fax:
Mailing address:
  • Phone: 913-491-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2026005787
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: