Provider Demographics
NPI:1235690546
Name:HACKWARD, DARIS ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:DARIS
Middle Name:ANN
Last Name:HACKWARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DARIS
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8551 BLUEJACKET ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1656
Mailing Address - Country:US
Mailing Address - Phone:913-981-1215
Mailing Address - Fax:913-439-4823
Practice Address - Street 1:20375 W 151ST ST STE 409
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7210
Practice Address - Country:US
Practice Address - Phone:913-780-3388
Practice Address - Fax:913-780-3256
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1502231363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty