Provider Demographics
NPI:1699795112
Name:FILSINGER, KENNETH BRIAN (PA-C)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:BRIAN
Last Name:FILSINGER
Suffix:
Gender:M
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 1:325 MAINE STREET
Mailing Address - Street 2:MSO LIBRARY
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044
Mailing Address - Country:US
Mailing Address - Phone:785-505-2988
Mailing Address - Fax:785-505-5228
Practice Address - Street 1:6265 ROCK CHALK DR STE 1500
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-5232
Practice Address - Country:US
Practice Address - Phone:785-843-9125
Practice Address - Fax:785-505-5312
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00897363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS122861OtherAAPA ID
KS15-00897OtherKS LICENSE
KS15-00897OtherKS LICENSE
KS392B477Medicare ID - Type UnspecifiedMEDICARE PROVIDER
KSMF0714990OtherDEA #