Provider Demographics
NPI:1144221029
Name:WEBSTER, ELISKA C (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ELISKA
Middle Name:C
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NW MOCK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2500
Mailing Address - Country:US
Mailing Address - Phone:816-228-1000
Mailing Address - Fax:
Practice Address - Street 1:131 STANLEY AVE STE 202
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-6356
Practice Address - Country:US
Practice Address - Phone:970-586-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00708174400000X
MO2018017186363A00000X
COPA.0008283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS426764Medicare ID - Type Unspecified
KSF87740Medicare UPIN