Provider Demographics
NPI:1154305308
Name:KEHRBERG, CORINNE CAROL (RN ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:CAROL
Last Name:KEHRBERG
Suffix:
Gender:F
Credentials:RN ARNP
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:CAROL
Other - Last Name:IGNARSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:7570 W 21ST ST N
Mailing Address - Street 2:SUITE 1026-D
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1734
Mailing Address - Country:US
Mailing Address - Phone:316-729-6555
Mailing Address - Fax:316-634-4794
Practice Address - Street 1:7570 W 21ST ST N
Practice Address - Street 2:SUITE 1026-D
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1734
Practice Address - Country:US
Practice Address - Phone:316-729-6555
Practice Address - Fax:316-634-4794
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1433388041163W00000X
KS74516163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4286852001Medicaid
KS1433388041OtherKANSAS STATE BOARD OF NURSING
KS1433388041OtherKANSAS STATE BOARD OF NURSING
DCMK0536853OtherDEA LICENSE
S28497Medicare UPIN