Provider Demographics
NPI:1063481026
Name:KISH, ANITA (PA)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:KISH
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 1:20375 W 151ST ST
Mailing Address - Street 2:STE 354
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5350
Mailing Address - Country:US
Mailing Address - Phone:913-393-9898
Mailing Address - Fax:913-393-9893
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:STE 354
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5350
Practice Address - Country:US
Practice Address - Phone:913-393-9898
Practice Address - Fax:913-393-9893
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO1043037363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP10094Medicare UPIN
MO263D557AMedicare ID - Type UnspecifiedMEDICARE NUMBER