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General NPI Number Information
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NPI Number | 1396796991
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Entity Type | Organization
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Legal Business Name | WICHITA MEDICAL ASSOCIATES, PA
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 10/01/2021
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Provider Practice Location Address
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Address Line | 347 S LAURA ST
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City | WICHITA
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State | KS
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Zip | 67211
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Country | US
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Telephone | 316-686-7117
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Fax | 316-686-2679
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Provider Business Mailing Address
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Address Line | 347 S. LAURA ST.
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City | WICHITA
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State | KS
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Zip | 67211-1518
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Country | US
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Telephone | 316-686-7117
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Fax | 316-686-2679
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | KAREN M HERNANDEZ
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Credential |
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Telephone | 316-686-7117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 74898
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 44906
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 19204
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License Number State | KS
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