Provider Demographics
NPI:1215972849
Name:HATFIELD, ALLYSON A (MD)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:A
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9102
Practice Address - Street 1:818 N CARRIAGE PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4511
Practice Address - Country:US
Practice Address - Phone:316-651-2314
Practice Address - Fax:316-651-2314
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS25340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS040862OtherBCBS
KS100444OtherHPK
KS12149529OtherMULTIPLAN
KS2817OtherPHS
KS16948OtherCOVENTRY
KS12149529OtherMULTIPLAN
KS040862Medicare ID - Type Unspecified