Provider Demographics
NPI:1255332680
Name:HERSHBERGER, KATHY L (PA)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:L
Last Name:HERSHBERGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:L
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPT CH 14389
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60055-4389
Mailing Address - Country:US
Mailing Address - Phone:785-295-5307
Mailing Address - Fax:785-270-7646
Practice Address - Street 1:634 SW MULVANE STEET
Practice Address - Street 2:SUITE 100
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606
Practice Address - Country:US
Practice Address - Phone:785-295-7979
Practice Address - Fax:785-295-7996
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00785363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS042745OtherBC/BS
KS100401540AMedicaid
KS042745OtherBC/BS