Individual
MR. CECIL J FACKRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6333 LONG AVE, SUITE 360, SHAWNEE, KS 66216-2500
(913) 631-6330
(913) 631-6222
Mailing address
6333 LONG AVE, SUITE 360, SHAWNEE, KS 66216-2500
(913) 631-6330
(913) 631-6222
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-01306
KS
Other
Enumeration date
04/10/2007
Last updated
03/15/2017
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