Provider Demographics
NPI:1336142116
Name:WELCH, KATHRYN A (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:WELCH
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 1:220 S HILLSIDE ST STE A
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-2151
Mailing Address - Country:US
Mailing Address - Phone:316-686-6866
Mailing Address - Fax:316-686-9797
Practice Address - Street 1:220 S HILLSIDE ST STE A
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2151
Practice Address - Country:US
Practice Address - Phone:316-686-6866
Practice Address - Fax:316-686-9797
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00659363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS042558OtherBC/BS
KS100446140AMedicaid