Provider Demographics
NPI:1235874728
Name:WINGERT, EMMA KATHLEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:KATHLEEN
Last Name:WINGERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 N WEBB RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-8105
Mailing Address - Country:US
Mailing Address - Phone:316-350-5455
Mailing Address - Fax:866-669-6703
Practice Address - Street 1:3161 N WEBB RD STE 200
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8105
Practice Address - Country:US
Practice Address - Phone:316-350-5455
Practice Address - Fax:966-669-6703
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
KS15-02624363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1193265OtherNCCPA ID