MEDICARE: KARLY KOTHE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1821989781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLY KOTHE PA

Provider Business Mailing Address
First Line	:	12738 E BIRCHWOOD DR
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-3619
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12738 E BIRCHWOOD DR
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-3619
Country	:	US
Telephone Number	:	316-371-9766
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2025
Last Update Date	:	10/16/2025

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Directions to “ KARLY KOTHE PA” Practice Location

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