Provider Demographics
NPI:1780968701
Name:SUMMERHAYS, MISHA ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:MISHA
Middle Name:ANNE
Last Name:SUMMERHAYS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MISHA
Other - Middle Name:A
Other - Last Name:HOLTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:2707 W EDGEWOOD DR
Practice Address - Street 2:SUITE 102
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5888
Practice Address - Country:US
Practice Address - Phone:573-761-1830
Practice Address - Fax:573-761-1829
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014020543363A00000X, 363AM0700X
OH50.003318363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical