Provider Demographics
NPI:1932681954
Name:KLENK, RACHEL DOROTHEA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:DOROTHEA
Last Name:KLENK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:DOROTHEA
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:100 E MAIN ST.
Mailing Address - Street 2:#317
Mailing Address - City:MERIDEN
Mailing Address - State:KS
Mailing Address - Zip Code:66512
Mailing Address - Country:US
Mailing Address - Phone:785-484-0100
Mailing Address - Fax:785-484-2074
Practice Address - Street 1:100 E MAIN ST.
Practice Address - Street 2:#317
Practice Address - City:MERIDEN
Practice Address - State:KS
Practice Address - Zip Code:66512
Practice Address - Country:US
Practice Address - Phone:785-484-0100
Practice Address - Fax:785-484-2074
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS78354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily