Provider Demographics
NPI:1386743094
Name:HERNANDEZ, SONIA (PA)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PA
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 1522
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-1522
Mailing Address - Country:US
Mailing Address - Phone:316-685-7234
Mailing Address - Fax:316-685-0317
Practice Address - Street 1:3232 E MURDOCK
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3003
Practice Address - Country:US
Practice Address - Phone:316-685-7234
Practice Address - Fax:316-685-0317
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01065363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant