Provider Demographics
NPI:1568418671
Name:O'MARA, CAROL J (ARNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:O'MARA
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 1:929 N SAINT FRANCIS ST
Mailing Address - Street 2:ER
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3821
Mailing Address - Country:US
Mailing Address - Phone:316-268-5775
Mailing Address - Fax:316-291-7496
Practice Address - Street 1:929 N SAINT FRANCIS ST
Practice Address - Street 2:ER
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-268-5775
Practice Address - Fax:316-291-7496
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200004890CMedicaid
KS200004890AMedicaid
KS45039OtherARNP LICENSE
KS161186Medicare PIN
KS004052014Medicare PIN
KS45039OtherARNP LICENSE