Provider Demographics
NPI:1336954106
Name:MEDILL, PAMELA LYNN (MSN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:MEDILL
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-5204
Mailing Address - Country:US
Mailing Address - Phone:913-240-2067
Mailing Address - Fax:
Practice Address - Street 1:965 CLEARVIEW DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-5204
Practice Address - Country:US
Practice Address - Phone:913-240-2067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-120945-102163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult