Provider Demographics
NPI:1013654193
Name:CUSKELLY, RACHEL MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MARIE
Last Name:CUSKELLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7550 W VILLAGE CIR STE 1
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-9364
Mailing Address - Country:US
Mailing Address - Phone:316-838-2020
Mailing Address - Fax:316-636-4076
Practice Address - Street 1:7550 W VILLAGE CIR STE 1
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-9364
Practice Address - Country:US
Practice Address - Phone:316-838-2020
Practice Address - Fax:316-636-4076
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02672363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant