Provider Demographics
NPI:1659380921
Name:HETTINGER, ALLISON S (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:S
Last Name:HETTINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:SUTHERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:824 W. FRONTIER LANE
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061
Mailing Address - Country:US
Mailing Address - Phone:913-764-7060
Mailing Address - Fax:913-764-8059
Practice Address - Street 1:824 W. FRONTIER LANE
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061
Practice Address - Country:US
Practice Address - Phone:913-764-7060
Practice Address - Fax:913-764-8059
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0434680208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN224120100Medicaid
KS200686350AMedicaid
MN224120100Medicaid
MN370003543Medicare PIN