=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053426114
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KERI J WEHLING PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 N HILLSIDE ST
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67214-4910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-962-2975
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15555 SW 150TH ST
-----------------------------------------------------
City | ROSE HILL
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67133-8002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-308-5072
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 1501089
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------