Provider Demographics
NPI:1740427095
Name:NUNEZ, KATHY CARLA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:CARLA
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:CARLA
Other - Last Name:WESSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3535 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-8127
Mailing Address - Country:US
Mailing Address - Phone:316-686-5300
Mailing Address - Fax:316-651-2660
Practice Address - Street 1:551 N HILLSIDE ST STE 410
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4927
Practice Address - Country:US
Practice Address - Phone:316-686-5300
Practice Address - Fax:316-686-5300
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01308363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200613360EMedicaid
KSKA3651020OtherMEDICARE