Healthcare Provider Details

I. General information

NPI: 1205597135
Provider Name (Legal Business Name): SIDNEY ANN KOTHE MHS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 1/2 E 17TH AVE
HUTCHINSON KS
67501-1102
US

IV. Provider business mailing address

1805 1/2 E 17TH AVE
HUTCHINSON KS
67501-1102
US

V. Phone/Fax

Practice location:
  • Phone: 620-615-7197
  • Fax:
Mailing address:
  • Phone: 620-615-7197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-02571
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: