Provider Demographics
NPI:1205140621
Name:FELL, OPAL PEGGYSUE (ARNP)
Entity type:Individual
Prefix:
First Name:OPAL
Middle Name:PEGGYSUE
Last Name:FELL
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 1:1301 W 12TH AVE
Mailing Address - Street 2:STE 401
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2587
Mailing Address - Country:US
Mailing Address - Phone:620-343-2900
Mailing Address - Fax:620-343-9484
Practice Address - Street 1:1301 W 12TH AVE
Practice Address - Street 2:STE 401
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2587
Practice Address - Country:US
Practice Address - Phone:620-343-2900
Practice Address - Fax:620-343-9484
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75138-122363LA2200X
KS75138363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002355OtherMEDICARE PTAN