Provider Demographics
NPI:1649728254
Name:BARNICKLE, KELSEY (APRN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BARNICKLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10209 W CENTRAL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4685
Mailing Address - Country:US
Mailing Address - Phone:316-837-1454
Mailing Address - Fax:
Practice Address - Street 1:10209 W CENTRAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4685
Practice Address - Country:US
Practice Address - Phone:316-837-1454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77368363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
003719494OtherMEDICARE