Provider Demographics
NPI:1427001064
Name:HANCOCK, KRISTIN ELAINE (PA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELAINE
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 W DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-6869
Mailing Address - Country:US
Mailing Address - Phone:913-856-8300
Mailing Address - Fax:913-856-8711
Practice Address - Street 1:2090 W DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-6869
Practice Address - Country:US
Practice Address - Phone:913-356-8300
Practice Address - Fax:913-356-8711
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500781363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS033D00246OtherWPS-MEDICARE
KS100403480CMedicaid