MEDICARE: MS. CONSTANCE PATRICIA ACKER PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	15-00233	KS

General Provider Information

NPI Number	:	1366418451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CONSTANCE PATRICIA ACKER PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	425 E 61ST ST N
Second Line	:	SUITE #2
City	:	PARK CITY
State	:	KS
Zip	:	67219-1903
Country	:	US
Telephone Number	:	316-744-3400
Fax Number	:	316-744-3800

Provider Business Practice Location Address
First Line	:	425 E 61ST ST N
Second Line	:	SUITE #2
City	:	PARK CITY
State	:	KS
Zip	:	67219-1903
Country	:	US
Telephone Number	:	316-744-3400
Fax Number	:	316-744-3800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	02/19/2014

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