Provider Demographics
NPI:1447487780
Name:GAVULA, VERONICA M (PA-C)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:M
Last Name:GAVULA
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 1:12113 MASTIN ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1668
Mailing Address - Country:US
Mailing Address - Phone:913-991-8032
Mailing Address - Fax:
Practice Address - Street 1:12200 W 106TH ST STE 315
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2305
Practice Address - Country:US
Practice Address - Phone:816-363-2500
Practice Address - Fax:816-361-4500
Is Sole Proprietor?:No
Enumeration Date:2009-06-13
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01311363A00000X
MO2009019847363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO248A00005Medicare PIN
KS248B00007Medicare PIN