Provider Demographics
NPI:1497720981
Name:THIESSEN, KATHRYN D (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:D
Last Name:THIESSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N. KANSAS
Mailing Address - Street 2:SUITE #3049
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3199
Mailing Address - Country:US
Mailing Address - Phone:316-293-1840
Mailing Address - Fax:316-293-1882
Practice Address - Street 1:1001 N MINNEAPOLIS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3127
Practice Address - Country:US
Practice Address - Phone:316-293-1840
Practice Address - Fax:316-293-2670
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74700363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP22523Medicare UPIN