Provider Demographics
NPI:1821500109
Name:KINDERKNECHT, SARAH R (APRN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:R
Last Name:KINDERKNECHT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:R
Other - Last Name:HACKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:10111 E 21ST ST N STE 106
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3555
Mailing Address - Country:US
Mailing Address - Phone:316-706-6079
Mailing Address - Fax:
Practice Address - Street 1:3223 N WEBB RD STE 3
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8176
Practice Address - Country:US
Practice Address - Phone:316-462-5072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77850363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty