Provider Demographics
NPI:1619248325
Name:FREUND, KELLY D (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:D
Last Name:FREUND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7329 W. VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-6255
Mailing Address - Country:US
Mailing Address - Phone:316-260-6363
Mailing Address - Fax:316-260-6301
Practice Address - Street 1:7329 W. VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205
Practice Address - Country:US
Practice Address - Phone:316-260-6363
Practice Address - Fax:316-260-6301
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2284002Medicare PIN