Provider Demographics
NPI:1689907172
Name:HICKEL, KATRINA L (RT (R) (M))
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:L
Last Name:HICKEL
Suffix:
Gender:F
Credentials:RT (R) (M)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 LAKIN AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3660
Mailing Address - Country:US
Mailing Address - Phone:620-792-5827
Mailing Address - Fax:620-792-2424
Practice Address - Street 1:3520 LAKIN AVE
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3660
Practice Address - Country:US
Practice Address - Phone:620-792-5827
Practice Address - Fax:620-792-2424
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS22-029212471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1154382737Medicaid
1154382737Medicare UPIN
1154382737Medicare PIN
KS1154382737Medicaid