Provider Demographics
NPI:1205597135
Name:KOTHE, SIDNEY ANN (MHS, PA-C)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:ANN
Last Name:KOTHE
Suffix:
Gender:F
Credentials:MHS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 1/2 E 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-1102
Mailing Address - Country:US
Mailing Address - Phone:620-615-7197
Mailing Address - Fax:
Practice Address - Street 1:1805 1/2 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-1102
Practice Address - Country:US
Practice Address - Phone:620-615-7197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02571363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant