Provider Demographics
NPI:1497235378
Name:BENSON, AMY ALYSSA (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ALYSSA
Last Name:BENSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ALYSSA
Other - Last Name:FINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8940 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-1646
Mailing Address - Country:US
Mailing Address - Phone:913-596-1313
Mailing Address - Fax:913-596-2422
Practice Address - Street 1:15435 W 134TH PL STE 101
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-6135
Practice Address - Country:US
Practice Address - Phone:913-355-7520
Practice Address - Fax:913-782-2924
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02124363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant