Provider Demographics
NPI:1285035022
Name:MONTELONGO, KARLA S (APRN)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:S
Last Name:MONTELONGO
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 1:4747 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67216-1739
Mailing Address - Country:US
Mailing Address - Phone:316-529-3084
Mailing Address - Fax:616-529-3085
Practice Address - Street 1:4747 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67216-1739
Practice Address - Country:US
Practice Address - Phone:316-529-3084
Practice Address - Fax:316-529-3085
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76348-021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily