Provider Demographics
NPI:1154639185
Name:DUKICH, JEAN T (CNS-BC)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:T
Last Name:DUKICH
Suffix:
Gender:F
Credentials:CNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1897
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-1897
Mailing Address - Country:US
Mailing Address - Phone:316-268-8131
Mailing Address - Fax:316-291-4788
Practice Address - Street 1:848 N SAINT FRANCIS ST
Practice Address - Street 2:SUITE 1900
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3841
Practice Address - Country:US
Practice Address - Phone:316-268-5881
Practice Address - Fax:316-268-8159
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-74439364S00000X
KS34090163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100254720BMedicaid
KS100254720BMedicaid