Provider Demographics
NPI:1255340360
Name:WOODEN, SHAWNA (PA)
Entity type:Individual
Prefix:MS
First Name:SHAWNA
Middle Name:
Last Name:WOODEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:SHAWNA
Other - Middle Name:
Other - Last Name:WOODEN-GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 47669
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-7669
Mailing Address - Country:US
Mailing Address - Phone:316-265-1308
Mailing Address - Fax:316-265-4480
Practice Address - Street 1:9350 E 35TH ST N STE 101
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2022
Practice Address - Country:US
Practice Address - Phone:316-265-1308
Practice Address - Fax:316-265-4480
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00351363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100343090AMedicaid
KS042426OtherMEDICARE
KS17954OtherPHS
S95634Medicare UPIN
KS100343090AMedicaid