Provider Demographics
NPI:1932217296
Name:EATON, MICHELLE S (PA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:EATON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 616788
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-6788
Mailing Address - Country:US
Mailing Address - Phone:407-533-6837
Mailing Address - Fax:407-770-0661
Practice Address - Street 1:16575 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7770
Practice Address - Country:US
Practice Address - Phone:913-815-5508
Practice Address - Fax:855-446-7281
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018035240363A00000X
KS150475363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S68829Medicare UPIN