Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 44460 | KS |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 2017028577 | MO |
NPI | 1164635637 |
---|---|
Provider Name | Pamela Marie Bevan |
First Address | Kansas City, MO 64124-2323 |
Second Address | Kansas City, MO 64124-2323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 28/09/2017 |