Provider Demographics
NPI:1750504197
Name:HUSS, BONNIE JEAN (ARNP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JEAN
Last Name:HUSS
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 1:347 S LAURA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-1518
Mailing Address - Country:US
Mailing Address - Phone:163-686-7117
Mailing Address - Fax:163-686-2679
Practice Address - Street 1:347 S LAURA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211
Practice Address - Country:US
Practice Address - Phone:163-686-7117
Practice Address - Fax:163-686-2679
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1773913363L00000X
KS45047363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200327800FMedicaid
73-0765084OtherOTHER
1750504197OtherNPI
KS53-45047OtherKANSAS STATE BOARD OF NURSING LICENSE
KS53-45047OtherKANSAS STATE BOARD OF NURSING LICENSE
MH0681468OtherDEA