Provider Demographics
NPI:1376715557
Name:HISAW, ARIANA MILLING (PA-C)
Entity Type:Individual
Prefix:
First Name:ARIANA
Middle Name:MILLING
Last Name:HISAW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12140 NALL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2504
Mailing Address - Country:US
Mailing Address - Phone:816-943-0706
Mailing Address - Fax:913-451-1754
Practice Address - Street 1:12140 NALL AVE STE 100
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2504
Practice Address - Country:US
Practice Address - Phone:816-943-0706
Practice Address - Fax:913-451-1754
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195338201Medicaid
TXP00611203OtherRAIL ROAD MEDICARE
TXP00611203OtherRAIL ROAD MEDICARE