Mikaela Ann Altis, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

550 Pope Ave
Fort Leavenworth, KS 66027-2332

Phone

(913) 684-6258

NPI assigned

Aug 13, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jackson County Memorial Hospital Authority

  • General Acute Care Hospital
  • Altus, OK
  • NPI 1093763781

  Single Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729209600000",
    "number": "1366053241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 POPE AVE",
            "city": "FORT LEAVENWORTH",
            "state": "KS",
            "postal_code": "660272332",
            "telephone_number": "913-684-6258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 POPE AVE",
            "city": "FORT LEAVENWORTH",
            "state": "KS",
            "postal_code": "660272332",
            "telephone_number": "913-684-6258"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "315 W Gary Blvd",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "OK",
            "postal_code": "736012835",
            "country_code": "US",
            "telephone_number": "580-547-0900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3600 N Garfield St",
            "address_purpose": "LOCATION",
            "city": "Midland",
            "state": "TX",
            "postal_code": "797056329",
            "country_code": "US",
            "telephone_number": "806-743-3220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALTIS",
        "first_name": "MIKAELA",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-13",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grant E Adams, DO
• Trenton Guyer Adams, DMD
• Ahc Munson-Leavenworth
• Ahc Munson-Leavenworth
• Lisa L Anderson-Pauly, RN
• Carolyn Cloud Anderson, REGISTERED NURSE
• Marie Arceo
• Patrick Jon Armistead-Jehle, PHD
• Sylvia Cena Arvizu

• Medical Physician Assistant in Fort Leavenworth, KS
• Providers in Fort Leavenworth, KS by specialty
• Medical Physician Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.