Provider Demographics
NPI:1003896689
Name:WOLF, KRISTEN (PA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:316-260-1690
Mailing Address - Fax:316-260-1691
Practice Address - Street 1:2600 N WOODLAWN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2729
Practice Address - Country:US
Practice Address - Phone:316-260-1690
Practice Address - Fax:316-260-1691
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00495363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100376430BMedicaid
KS100376430CMedicaid
KS100376430CMedicaid
KSS62347Medicare UPIN
KS100376430BMedicaid
KSKA2473020Medicare PIN