Provider Demographics
NPI:1053306910
Name:LEVI, VICKI A (PA)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:A
Last Name:LEVI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 W 119TH ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3722
Mailing Address - Country:US
Mailing Address - Phone:913-345-3650
Mailing Address - Fax:913-345-3797
Practice Address - Street 1:5701 W 119TH ST
Practice Address - Street 2:SUITE 410
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3722
Practice Address - Country:US
Practice Address - Phone:913-345-3650
Practice Address - Fax:913-345-3797
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-00120363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP72574Medicare UPIN
KSN89C097Medicare ID - Type Unspecified
KSP03C097Medicare PIN