Provider Demographics
NPI:1275785032
Name:REA, CAROLYN M (APRN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:REA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6021 SW 29TH ST # STL
Mailing Address - Street 2:SUITE A PMB 358
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-6200
Mailing Address - Country:US
Mailing Address - Phone:316-722-2448
Mailing Address - Fax:866-316-4467
Practice Address - Street 1:2641 SW WANAMAKER RD
Practice Address - Street 2:SUITE 301
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4969
Practice Address - Country:US
Practice Address - Phone:785-408-5228
Practice Address - Fax:785-783-8026
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily