Provider Demographics
NPI:1861489007
Name:HORTON, CARISSA A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CARISSA
Middle Name:A
Last Name:HORTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:A
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4201 ANDERSON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-7603
Mailing Address - Country:US
Mailing Address - Phone:785-539-3504
Mailing Address - Fax:785-539-8597
Practice Address - Street 1:4201 ANDERSON AVE STE C
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7603
Practice Address - Country:US
Practice Address - Phone:785-539-3504
Practice Address - Fax:785-539-8597
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-01033363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200300400AMedicaid
KS426807OtherBLUE CROSS BLUE SHIELD
KS200300400AMedicaid
KSQ29767Medicare UPIN
KS014060Medicare Oscar/Certification