Provider Demographics
NPI:1235148305
Name:EBERSOLE, SHEILA (ARNP)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:EBERSOLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-2361
Mailing Address - Country:US
Mailing Address - Phone:316-775-7500
Mailing Address - Fax:316-775-7500
Practice Address - Street 1:2820 OHIO ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-2361
Practice Address - Country:US
Practice Address - Phone:316-775-7500
Practice Address - Fax:316-775-7500
Is Sole Proprietor?:No
Enumeration Date:2006-08-06
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100426830AMedicaid
P68204Medicare UPIN
KS100426830AMedicaid
KS160859Medicare ID - Type Unspecified
KS203718OtherHPK
P68204Medicare UPIN