NPI 1366053241 · live from the CMS NPI Registry
Mikaela Ann Altis, PA-C
Physician Assistant, Medical in Fort Leavenworth, KS. National Provider Identifier 1366053241, active.
NPI record
| NPI | 1366053241 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant, Medical 363AM0700X |
| Practice location | 550 Pope Ave, Fort Leavenworth, KS 66027 |
| Practice phone | 913-684-6258 |
| Enumerated | August 13, 2020 |
| Last updated | October 18, 2024 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | — |
| Physician Assistant, Medical primary | 363AM0700X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.