Healthcare Provider Details

I. General information

NPI: 1508425141
Provider Name (Legal Business Name): EMILY ANN WESTERMAN WADEL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 09/11/2025
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ROSS BLVD
DODGE CITY KS
67801-7221
US

IV. Provider business mailing address

17400 SW 110 AVE
ZENDA KS
67159-9089
US

V. Phone/Fax

Practice location:
  • Phone: 620-371-7300
  • Fax:
Mailing address:
  • Phone: 620-243-2653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5378786032
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: