Healthcare Provider Details

I. General information

NPI: 1164856613
Provider Name (Legal Business Name): MINDY JO KOBBEMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MINDY JO SCHRADER PA-C

II. Dates (important events)

Enumeration Date: 09/02/2013
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10346 E STONEGATE LN STE 100
WICHITA KS
67206-2054
US

IV. Provider business mailing address

10346 E STONEGATE LN STE 100
WICHITA KS
67206-2054
US

V. Phone/Fax

Practice location:
  • Phone: 316-871-0995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-01626
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: