Basic Information
| Provider Information | |||||||||
| NPI: | 1780959536 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PROCTOR | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | BETH | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7501 METCALF AVE | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662042927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136426330 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7501 METCALF AVE | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662042927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136426330 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2012 | ||||||||
| LastUpdateDate: | 10/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 53-75617-062 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 53-75617-062 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 200867740A | 05 | KS | MEDICAID | 068002162 | 01 | KS | MEDICARE PTAN | OTHER |