Provider Demographics
NPI:1528396421
Name:MEFFORD, RAE LYN (APRN)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:LYN
Last Name:MEFFORD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9505 W CENTRAL AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3801
Mailing Address - Country:US
Mailing Address - Phone:316-312-0002
Mailing Address - Fax:316-854-5644
Practice Address - Street 1:3450 N ROCK RD STE 503
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1355
Practice Address - Country:US
Practice Address - Phone:316-312-0002
Practice Address - Fax:316-854-5644
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2018-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS45062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100367010CMedicaid
KSKA2300002Medicare PIN
KS100367010CMedicaid