Provider Demographics
NPI:1770058653
Name:HOEKSEMA, WILLIAM RYAN (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RYAN
Last Name:HOEKSEMA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 OLATHE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-9204
Mailing Address - Country:US
Mailing Address - Phone:913-588-2200
Mailing Address - Fax:913-588-8423
Practice Address - Street 1:2000 OLATHE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-9268
Practice Address - Country:US
Practice Address - Phone:913-588-2200
Practice Address - Fax:913-588-8423
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02153363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004621750001Medicaid