Provider Demographics
NPI:1679616478
Name:BLAND, CAROLYN A (PA)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:BLAND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:144 S HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-2154
Mailing Address - Country:US
Mailing Address - Phone:316-682-9900
Mailing Address - Fax:316-682-0311
Practice Address - Street 1:144 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2154
Practice Address - Country:US
Practice Address - Phone:316-682-9900
Practice Address - Fax:316-682-0311
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-01092363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200355270AMedicaid
KS200355270AMedicaid
Q59169Medicare UPIN