Provider Demographics
NPI:1750016937
Name:WOLTERS, JESSICA KATE (APRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KATE
Last Name:WOLTERS
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 1:511 S SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4145
Mailing Address - Country:US
Mailing Address - Phone:785-452-4860
Mailing Address - Fax:785-452-4878
Practice Address - Street 1:511 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4145
Practice Address - Country:US
Practice Address - Phone:785-452-4860
Practice Address - Fax:785-452-4878
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-81382-021363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner