MARK LEE PEMBERTON (NPI# 1669433652) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669433652 |
| Entity Type | Individual |
| Full Name | MARK LEE PEMBERTON |
| Credential | PAC |
| Practice Address |
9119 W 74th St Ste 260 Shawnee Mission KS 66204-2268 |
| Mailing Address |
9119 W 74th Street Suite 260 Shawnee Mission KS 66204 |
| Practice Telephone | (913) 632-9480 |
| Practice Fax Number | 9136329499 |
| Mailing Telephone | 9136329480 |
| Mailing Fax Number | 9136329499 |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2017-08-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
1500212 | KS | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396103057 | Mark Pemberton | Counselor | 1925 Hayes Ave, Sandusky, OH 44870-4737 | 2016-02-09 |
| Street Address |
9119 W 74TH ST STE 260 |
| City | SHAWNEE MISSION |
| State | KS |
| Zip Code | 66204-2268 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326652405 | Avenue 81 Iaop | Assisted Living Facility | 8055 Metcalf Ave, Overland Park, KS 66204 | 2020-09-04 |
| 1487160255 | Femme Focus, L.L.C. | Clinic/Center | 7927 Floyd, Rm 5, Home Family Holistic Center, Overland Park, KS 66204 | 2017-12-15 |
| 1427577469 | Linda Kay Mufich-knopp | Physical Therapist | Femme Focus, L.L.C. In The Home Family Holistic Center, 7927 Floyd Street, Suite 5, Overland Park, KS 66204 | 2017-09-11 |
| 1700304789 | Kalli Dee Karmann | Occupational Therapy Assistant | 6814 W 72nd St, Overland Park, KS 66204 | 2017-08-30 |
| 1164951786 | Daniel Collins | Physical Therapist | 10000 W. 75th St. Ste. 250, Merriam, KS 66204 | 2017-06-07 |
| 1942686530 | Anna Katheryn Grantham | Speech-Language Pathologist | 10000 W. 75th St., Suite 250, Merriam, KS 66204 | 2015-08-05 |
| 1700262680 | Maple Hills Healthcare, Inc. | Skilled Nursing Facility | 7600 Antioch Rd, Overland Park, KS 66204 | 2015-08-03 |
| 1104211085 | John Brainard | Pediatrics | 8901 W 74th St Ste 10, Shawnee Mission, KS 66204 | 2015-03-30 |
| 1477941318 | Shelley Watts | Occupational Therapy Assistant | 6712 W 72nd Street, Overland Park, KS 66204 | 2014-12-30 |
| 1578963369 | James Aaron Mitchum | Counselor | 7923 Santa Fe Dr, Overland Park, KS 66204 | 2014-08-28 |
| Find all providers in zip 66204 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447559752 | Edwin Joshua Crosier | Physician Assistant | 9301 W 74th St, Suite 230, Shawnee Mission, KS 66204-2207 | 2011-03-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023675725 | Jordan Levi Walter | Physician Assistant | Associated Urologsits P A, 1133 College Ave G100, Manhattan, KS 66502-2756 | 2019-05-29 |
| 1316217102 | Tina L Lee | Physician Assistant | 15263 Sweetbriar Dr, Basehor, KS 66007-3031 | 2012-01-10 |
| 1407098395 | Kara Leigh-lawless Boyd | Physician Assistant | 3651 College Boulevard, Leawood, KS 66211 | 2009-03-24 |
| 1053446708 | Eastern Surgical Assistants, LLC | Physician Assistant | 16427 Metro Ave, Bonner Springs, KS 66012-7108 | 2007-02-22 |
| 1730223785 | Ty M. Taylor | Physician Assistant | 8321 Alden St, Lenexa, KS 66215-4213 | 2007-02-16 |
| 1366457038 | Gustav Thomas Riemer | Physician Assistant | 9119 W. 74th Street, Suite 354, Shawnee Mission Medical Building, Merriam, KS 66204 | 2006-07-30 |
| 1699795112 | Kenneth Brian Filsinger | Physician Assistant | 1112 W 6th St Ste 124, Lawrence, KS 66044-2249 | 2006-07-20 |
| 1962435552 | Gregory Bryan De Laney | Physician Assistant | 1431 Bluffview St Ste 210, Wichita, KS 67218-3039 | 2006-07-08 |
| 1538122973 | Leah Alpers | Physician Assistant | 351 W 10th St, Hoisington, KS 67544-1715 | 2006-04-07 |
| 1275596611 | Anne Linenberger | Physician Assistant | 1514 K 96 Highway, Great Bend, KS 67530 | 2006-04-07 |
| Find all providers with the same taxonomy | ||||
| City | SHAWNEE MISSION |
| Zip Code | 66204 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.