Provider Demographics
NPI:1164856613
Name:KOBBEMAN, MINDY JO (PA-C)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:JO
Last Name:KOBBEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:JO
Other - Last Name:SCHRADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3715 N OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-3404
Mailing Address - Country:US
Mailing Address - Phone:316-942-4519
Mailing Address - Fax:316-942-4655
Practice Address - Street 1:3715 N OLIVER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-3404
Practice Address - Country:US
Practice Address - Phone:316-942-4519
Practice Address - Fax:316-942-4655
Is Sole Proprietor?:No
Enumeration Date:2013-09-02
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01626363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant