Healthcare Provider Details

I. General information

NPI: 1659236065
Provider Name (Legal Business Name): ASHLEE MARIE WATERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 N MAIN ST
WICHITA KS
67203-3608
US

IV. Provider business mailing address

1805 E 30TH AVE
HUTCHINSON KS
67502-1237
US

V. Phone/Fax

Practice location:
  • Phone: 316-617-0680
  • Fax:
Mailing address:
  • Phone: 620-755-6303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number1881730760
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: