Provider Demographics
NPI:1265971733
Name:FILLINGAME, CARL WESLEY (PA)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:WESLEY
Last Name:FILLINGAME
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Gender:M
Credentials:PA
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Mailing Address - Street 1:19550 E 39TH ST S STE 230
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2309
Mailing Address - Country:US
Mailing Address - Phone:816-795-6630
Mailing Address - Fax:816-795-6898
Practice Address - Street 1:19550 E 39TH ST S STE 230
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2309
Practice Address - Country:US
Practice Address - Phone:816-795-6630
Practice Address - Fax:816-795-6898
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2022-02-01
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Provider Licenses
StateLicense IDTaxonomies
MO363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical