Provider Demographics
NPI:1376518928
Name:PAULSON, CAROL HAMMON (PHD, RN, ARNP)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:HAMMON
Last Name:PAULSON
Suffix:
Gender:F
Credentials:PHD, RN, ARNP
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:LYNN
Other - Last Name:HAMMON-PAULSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, APRN
Mailing Address - Street 1:4972 N WYNDHAM CT.
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67219-5500
Mailing Address - Country:US
Mailing Address - Phone:316-832-2340
Mailing Address - Fax:316-838-4909
Practice Address - Street 1:4972 N. WYNDHAM CT.,
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67219-5500
Practice Address - Country:US
Practice Address - Phone:316-832-2340
Practice Address - Fax:316-838-4909
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS777103TC0700X
KS14051451041163W00000X
KS74458363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100241450DMedicaid
KS119794Medicare PIN
119794Medicare PIN
KS100241450DMedicaid