Provider Demographics
NPI:1134741879
Name:ECK, JOSIE ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:ELIZABETH
Last Name:ECK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 TENPOINT
Mailing Address - Street 2:
Mailing Address - City:ANDALE
Mailing Address - State:KS
Mailing Address - Zip Code:67001-9706
Mailing Address - Country:US
Mailing Address - Phone:316-706-8167
Mailing Address - Fax:
Practice Address - Street 1:5340 TENPOINT
Practice Address - Street 2:
Practice Address - City:ANDALE
Practice Address - State:KS
Practice Address - Zip Code:67001-9706
Practice Address - Country:US
Practice Address - Phone:316-706-8167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-16
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS1502385363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program