MEDICARE: MS. ANITA MARY LOUISON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	102438	MO

General Provider Information

NPI Number	:	1568461457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANITA MARY LOUISON PA-C

Provider Business Mailing Address
First Line	:	3801 BLUE PKWY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64130-2807
Country	:	US
Telephone Number	:	816-923-5800
Fax Number	:	816-922-7637

Provider Business Practice Location Address
First Line	:	3801 BLUE PKWY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64130-2807
Country	:	US
Telephone Number	:	816-923-5800
Fax Number	:	816-922-7637

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	12/03/2013

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