Healthcare Provider Details

I. General information

NPI: 1427001742
Provider Name (Legal Business Name): DAVID EUGENE FELLOWS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SE BLUE PKWY
LEES SUMMIT MO
64063-1007
US

IV. Provider business mailing address

2537 MOMENTUM PL EMERGENCY DEPARTMENT
CHICAGO IL
60689-5325
US

V. Phone/Fax

Practice location:
  • Phone: 816-282-5000
  • Fax:
Mailing address:
  • Phone: 913-205-8995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001321
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0894
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: