Provider Demographics
NPI:1013947779
Name:SIEFERS, JULIE LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:SIEFERS
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 1:409 S COCHRAN ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67663-2531
Mailing Address - Country:US
Mailing Address - Phone:785-877-3305
Mailing Address - Fax:785-877-3646
Practice Address - Street 1:409 S COCHRAN ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:KS
Practice Address - Zip Code:67663
Practice Address - Country:US
Practice Address - Phone:785-877-3305
Practice Address - Fax:785-877-3646
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00551207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSS75025Medicare UPIN
KS426890Medicare ID - Type UnspecifiedKANSAS MEDICARE PROVIDER