Provider Demographics
NPI:1477110138
Name:BAUER, KATELYN ELIZABETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:ELIZABETH
Last Name:BAUER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:GOCHENOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8020 E CENTRAL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2382
Mailing Address - Country:US
Mailing Address - Phone:316-636-2662
Mailing Address - Fax:316-636-2685
Practice Address - Street 1:8020 E CENTRAL AVE STE 200
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2382
Practice Address - Country:US
Practice Address - Phone:316-636-2662
Practice Address - Fax:316-636-2685
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02285363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004783610001Medicaid