Provider Demographics
NPI:1366418451
Name:ACKER, CONSTANCE PATRICIA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:PATRICIA
Last Name:ACKER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:425 E 61ST ST N
Mailing Address - Street 2:SUITE #2
Mailing Address - City:PARK CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67219-1903
Mailing Address - Country:US
Mailing Address - Phone:316-744-3400
Mailing Address - Fax:316-744-3800
Practice Address - Street 1:425 E 61ST ST N
Practice Address - Street 2:SUITE #2
Practice Address - City:PARK CITY
Practice Address - State:KS
Practice Address - Zip Code:67219-1903
Practice Address - Country:US
Practice Address - Phone:316-744-3400
Practice Address - Fax:316-744-3800
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-00233363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS35297Medicare ID - Type UnspecifiedBCBSKS MEDICARE