Healthcare Provider Details

I. General information

NPI: 1225421340
Provider Name (Legal Business Name): JESSICA HADWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 N COLLECTIVE LN
WICHITA KS
67206-3560
US

IV. Provider business mailing address

5901 S 127TH ST E
DERBY KS
67037-9275
US

V. Phone/Fax

Practice location:
  • Phone: 316-261-3220
  • Fax: 316-261-3298
Mailing address:
  • Phone: 316-516-0130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP10851
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number53-76676-032
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: