Provider Demographics
NPI:1891824645
Name:ADAY, JACQUELINE A (RN , CDE)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:ADAY
Suffix:
Gender:F
Credentials:RN , CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N KANSAS ST
Mailing Address - Street 2:SUITE #3054
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3124
Mailing Address - Country:US
Mailing Address - Phone:316-293-3429
Mailing Address - Fax:316-293-1882
Practice Address - Street 1:8533 E 32ND ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2611
Practice Address - Country:US
Practice Address - Phone:316-687-3100
Practice Address - Fax:316-293-1866
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1341647071163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS120527Medicare ID - Type Unspecified