Provider Demographics
NPI:1659482016
Name:HAASE, KRISTINA M (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:HAASE
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 1:2330 SHAWNEE MISSION PKWY
Mailing Address - Street 2:MEDICAL ADMINISTRATIVE SERVICES OF KU MED. STE 312
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2005
Mailing Address - Country:US
Mailing Address - Phone:913-588-9000
Mailing Address - Fax:913-588-9822
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:PROFESSIONAL SERVICES OF KU HOSPITAL
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-7743
Practice Address - Fax:913-588-9786
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-00970363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00237946OtherRR MEDICARE
10001770200OtherCHP PROVIDER NUMBER
928283OtherFIRSTGUARD
928283OtherFIRSTGUARD
KSK73D240Medicare PIN