Provider Demographics
NPI:1265733075
Name:ALLEN, VIRGINIA CLAIRE (PA-C)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:CLAIRE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:BUDKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4963 W. 135TH ST.
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224
Mailing Address - Country:US
Mailing Address - Phone:913-814-8222
Mailing Address - Fax:913-897-5574
Practice Address - Street 1:4963 W. 135TH ST.
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224
Practice Address - Country:US
Practice Address - Phone:913-814-8222
Practice Address - Fax:913-897-5574
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501459363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL385002700Medicaid
ILT00674Medicare PIN
IL1291050001Medicare NSC