Provider Demographics
NPI:1598760381
Name:SKINNER, PAULA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:
Last Name:SKINNER
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 1:635 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3602
Mailing Address - Country:US
Mailing Address - Phone:316-660-7621
Mailing Address - Fax:316-660-7510
Practice Address - Street 1:934 N WATER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3838
Practice Address - Country:US
Practice Address - Phone:316-660-7500
Practice Address - Fax:316-660-1897
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74175363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100254520CMedicaid
KS161043Medicare ID - Type Unspecified
KS100254520CMedicaid