Provider Demographics
NPI:1437125309
Name:GEORGE, NANCY (PA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:DENTON
Other - Suffix:
Other - Last Name Type:Former Name
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:316-219-4141
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:67226-2022
Practice Address - Country:US
Practice Address - Phone:316-265-1308
Practice Address - Fax:316-219-4141
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00726363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100373760EMedicaid
KS100373760EMedicaid
KSP16130Medicare UPIN