Provider Demographics
NPI:1952621450
Name:SISSON, KATHLEEN ELIZABETH (MS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:SISSON
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:ELIZABETH
Other - Last Name:PLAGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PA-C
Mailing Address - Street 1:75 BARCLAY CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5820
Mailing Address - Country:US
Mailing Address - Phone:248-853-9177
Mailing Address - Fax:248-853-7258
Practice Address - Street 1:75 BARCLAY CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5820
Practice Address - Country:US
Practice Address - Phone:248-853-9177
Practice Address - Fax:248-853-7258
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005723363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant