MEDICARE: INA WHITACRE 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	363A00000X	Physician Assistant	2012035063	MO

General Provider Information

NPI Number	:	1689926115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INA WHITACRE PA-C

Provider Business Mailing Address
First Line	:	920 MAIN ST
Second Line	:	SUITE 300
City	:	KANSAS CITY
State	:	MO
Zip	:	64105-2017
Country	:	US
Telephone Number	:	816-559-6369
Fax Number	:	816-559-6368

Provider Business Practice Location Address
First Line	:	920 MAIN ST
Second Line	:	SUITE 300
City	:	KANSAS CITY
State	:	MO
Zip	:	64105-2017
Country	:	US
Telephone Number	:	816-559-6359
Fax Number	:	816-559-6368

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

Provider Enumeration Date	:	10/08/2012
Last Update Date	:	10/08/2012

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Directions to “ INA WHITACRE PA-C” Practice Location

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