Healthcare Provider Details

I. General information

NPI: 1568461457
Provider Name (Legal Business Name): ANITA MARY LOUISON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BLUE PKWY
KANSAS CITY MO
64130-2807
US

IV. Provider business mailing address

3801 BLUE PKWY
KANSAS CITY MO
64130-2807
US

V. Phone/Fax

Practice location:
  • Phone: 816-923-5800
  • Fax: 816-922-7637
Mailing address:
  • Phone: 816-923-5800
  • Fax: 816-922-7637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number102438
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: