| Doctor Name: | SAMANTHA KISICKI |
| NPI Number: | 1043612609 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | PA0004002 |
| Business Practice Address: | 2790 Clay Edwards Dr Ste 1250 North Kansas City, MO - 641163260 |
| Business Phone Number: | 8164213700 |
| Business Fax Number: | 8164211654 |
| Mailing Address: | 2790 Clay Edwards Dr 1250, NORTH KANSAS CITY |
| State: | MO |
| Postal Code: | 641163260 |
| Phone Number: | 8164213700 |
| Fax Number: | 8164211654 |
| NPI Enumeration Date: | 09/25/2014 |
| NPI Last Update Date: | 02/12/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA0004002 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |