Provider Demographics
NPI:1164794368
Name:SERRANO, ALLISON O'BOYNICK (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:O'BOYNICK
Last Name:SERRANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:M
Other - Last Name:O'BOYNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9301 W 74TH ST
Mailing Address - Street 2:STE 225
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2207
Mailing Address - Country:US
Mailing Address - Phone:913-831-1003
Mailing Address - Fax:
Practice Address - Street 1:9301 W 74TH ST
Practice Address - Street 2:STE 225
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2207
Practice Address - Country:US
Practice Address - Phone:913-831-1003
Practice Address - Fax:913-831-4801
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01464363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01105744OtherRR MEDICARE
KSJ71000018Medicare PIN