Healthcare Provider Details

I. General information

NPI: 1699719203
Provider Name (Legal Business Name): ALICIA A. HUCKSTADT PHD, ARNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 FAIRMOUNT ST, BOX 41
WICHITA KS
67260-0001
US

IV. Provider business mailing address

13303 E. CAMDEN CHASE ST.
WICHITA KS
67228-8028
US

V. Phone/Fax

Practice location:
  • Phone: 316-978-5742
  • Fax: 316-978-3094
Mailing address:
  • Phone: 316-636-9248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5344403
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5344403
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: