Provider Demographics
NPI:1386096980
Name:SOMMER, COLLEEN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:SOMMER
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 1:1156 COUNTY LINE RD # 604
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66103-2374
Mailing Address - Country:US
Mailing Address - Phone:660-349-5164
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD LEVEL 3 OTOLARYNGOLOGY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-7601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01896363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant