Provider Demographics
NPI:1689767436
Name:FRUECHTING, PAMELA (ARNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:FRUECHTING
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 1:203 WATSON ST
Mailing Address - Street 2:STE 300
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-3066
Mailing Address - Country:US
Mailing Address - Phone:620-672-1002
Mailing Address - Fax:
Practice Address - Street 1:203 WATSON ST
Practice Address - Street 2:STE 300
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-3066
Practice Address - Country:US
Practice Address - Phone:620-672-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44646363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100400160AMedicaid
KSP26784Medicare UPIN
KS100400160AMedicaid