Provider Demographics
NPI:1760455331
Name:HANSEN, CHRIS (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:HANSEN
Suffix:
Gender:M
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:PO BOX 167
Mailing Address - Street 2:
Mailing Address - City:HOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:67740-0167
Mailing Address - Country:US
Mailing Address - Phone:856-775-3281
Mailing Address - Fax:785-675-3840
Practice Address - Street 1:826 18TH ST
Practice Address - Street 2:
Practice Address - City:HOXIE
Practice Address - State:KS
Practice Address - Zip Code:67740-4371
Practice Address - Country:US
Practice Address - Phone:785-675-3281
Practice Address - Fax:785-675-3840
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDA0280Medicaid
S84976Medicare UPIN