Provider Demographics
NPI:1871678896
Name:MIESCHER, CHERYL LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LEE
Last Name:MIESCHER
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 1:1035 N EMPORIA ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2944
Mailing Address - Country:US
Mailing Address - Phone:316-263-7285
Mailing Address - Fax:316-263-2666
Practice Address - Street 1:1035 N EMPORIA ST
Practice Address - Street 2:SUITE 105
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2944
Practice Address - Country:US
Practice Address - Phone:316-263-7285
Practice Address - Fax:316-263-2666
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00858363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P87636Medicare UPIN
426904Medicare ID - Type Unspecified