Provider Demographics
NPI:1750388559
Name:OSLAND, JACQUELINE S (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:S
Last Name:OSLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 N EMPORIA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3729
Mailing Address - Country:US
Mailing Address - Phone:316-263-0296
Mailing Address - Fax:316-263-9523
Practice Address - Street 1:390 FOUNDERS WAY
Practice Address - Street 2:
Practice Address - City:FORKS
Practice Address - State:WA
Practice Address - Zip Code:98331-9062
Practice Address - Country:US
Practice Address - Phone:360-374-6998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0424299208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100318690AMedicaid
KSG29442Medicare UPIN
KS100318690AMedicaid