Individual
MIKAELA ANN ALTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
550 POPE AVE, FORT LEAVENWORTH, KS 66027-2332
(913) 684-6258
Mailing address
550 POPE AVE, FORT LEAVENWORTH, KS 66027-2332
(913) 684-6258
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/13/2020
Last updated
10/18/2024
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