Provider Demographics
NPI:1871528323
Name:BYERLEY, CHRISTINA DIANE (PA C)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:DIANE
Last Name:BYERLEY
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:DIANE
Other - Last Name:NICKELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:12200 W 106TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2305
Mailing Address - Country:US
Mailing Address - Phone:913-541-5500
Mailing Address - Fax:913-541-7474
Practice Address - Street 1:12200 W 106TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2305
Practice Address - Country:US
Practice Address - Phone:913-541-8897
Practice Address - Fax:913-541-7474
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01079363AS0400X, 363AM0700X
MO2007030789363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q71229Medicare UPIN
KS248A00001Medicare PIN
MO248B00001Medicare PIN