Healthcare Provider Details

I. General information

NPI: 1225509334
Provider Name (Legal Business Name): JUANITTA OWUSU ABORAH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 PROSPECT AVE
KANSAS CITY MO
64128-1530
US

IV. Provider business mailing address

3027 PROSPECT AVE
KANSAS CITY MO
64128-1530
US

V. Phone/Fax

Practice location:
  • Phone: 816-861-6500
  • Fax: 816-861-6503
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6519
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number55683
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2020034329
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: