Provider Demographics
NPI:1285683599
Name:EDIGER, JACQUE ELAINE (ARNP,BC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUE
Middle Name:ELAINE
Last Name:EDIGER
Suffix:
Gender:F
Credentials:ARNP,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 S OSAGE ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:KS
Mailing Address - Zip Code:67022-1651
Mailing Address - Country:US
Mailing Address - Phone:620-845-6852
Mailing Address - Fax:
Practice Address - Street 1:5500 E KELLOGG DR
Practice Address - Street 2:BLDG 5- ROBERT J DOLE VA MEDICAL CENTER
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1607
Practice Address - Country:US
Practice Address - Phone:316-634-3058
Practice Address - Fax:316-634-3091
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74824364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS5615865701Medicaid
KS5615865701Medicaid