Provider Demographics
NPI:1710979265
Name:MEITLER, KAYANNE JOYCE (ARNP)
Entity Type:Individual
Prefix:
First Name:KAYANNE
Middle Name:JOYCE
Last Name:MEITLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KAYANNE
Other - Middle Name:JOYCE
Other - Last Name:HLADEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 S KANSAS ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665-3000
Mailing Address - Country:US
Mailing Address - Phone:785-483-3333
Mailing Address - Fax:785-483-0781
Practice Address - Street 1:222 S KANSAS ST
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-3000
Practice Address - Country:US
Practice Address - Phone:785-483-3333
Practice Address - Fax:785-483-0781
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1339486363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100399200AMedicaid
KS160545OtherBCBS
KS160545OtherBCBS
KS160545Medicare ID - Type Unspecified