Provider Demographics
NPI:1225509334
Name:OWUSU ABORAH, JUANITTA (PA-C)
Entity type:Individual
Prefix:
First Name:JUANITTA
Middle Name:
Last Name:OWUSU ABORAH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64128-1530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3027 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-1530
Practice Address - Country:US
Practice Address - Phone:816-861-6500
Practice Address - Fax:816-861-6503
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6519363A00000X
CA55683363A00000X
MO2020034329363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2020034329OtherSTATE LICENSE