Basic Information
| Provider Information | |||||||||
| NPI: | 1225013667 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AU.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KLINE | ||||||||
| OtherFirstName: | PAMELA | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5330 N OAK TRFY | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641184699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164540666 | ||||||||
| FaxNumber: | 8164541694 | ||||||||
| Practice Location | |||||||||
| Address1: | 5330 N OAK TRFY | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641184699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164540666 | ||||||||
| FaxNumber: | 8164541694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2005 | ||||||||
| LastUpdateDate: | 01/09/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 02073 | MO | Y | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | 580 | KS | N | Speech, Language and Hearing Service Providers | Audiologist | 237700000X | 001022 | MO | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | 0153 | KS | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 640002924 | 01 | MO | RAILROAD MEDICARE | OTHER | K872974 | 01 | KS | MEDICARE-KS | OTHER |