Provider Demographics
NPI:1417300294
Name:WETTA, STACIE HINKEL (APRN)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:HINKEL
Last Name:WETTA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 E 35TH ST N STE 101
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2022
Mailing Address - Country:US
Mailing Address - Phone:316-265-1308
Mailing Address - Fax:316-265-4480
Practice Address - Street 1:9350 E 35TH ST N STE 101
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226
Practice Address - Country:US
Practice Address - Phone:316-265-1308
Practice Address - Fax:316-265-4480
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily