Provider Demographics
NPI:1447205893
Name:WICHMANN, KATHRYN A (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:A
Last Name:WICHMANN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:MCKITTRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4101 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-7588
Mailing Address - Country:US
Mailing Address - Phone:785-587-4101
Mailing Address - Fax:785-587-9090
Practice Address - Street 1:4101 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7588
Practice Address - Country:US
Practice Address - Phone:785-587-4101
Practice Address - Fax:785-587-9090
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44875363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP11321Medicare UPIN
KS160898Medicare ID - Type Unspecified