MEDICARE: MISHA ANNE SUMMERHAYS PA-C

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	363A00000X	Physician Assistant	2014020543	MO

General Provider Information

NPI Number	:	1780968701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISHA ANNE SUMMERHAYS PA-C

Provider Business Mailing Address
First Line	:	PO BOX 843966
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64184-3966
Country	:	US
Telephone Number	:	573-884-3300
Fax Number	:	573-884-0943

Provider Business Practice Location Address
First Line	:	2707 W EDGEWOOD DR
Second Line	:	SUITE 102
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-5888
Country	:	US
Telephone Number	:	573-761-1830
Fax Number	:	573-761-1829

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

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	03/04/2022

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