Provider Demographics
NPI:1770755647
Name:EHLING, JENNI KAY (CRNA)
Entity type:Individual
Prefix:
First Name:JENNI
Middle Name:KAY
Last Name:EHLING
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JENNI
Other - Middle Name:KAY
Other - Last Name:THIMESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0356
Mailing Address - Country:US
Mailing Address - Phone:800-374-5326
Mailing Address - Fax:800-374-7656
Practice Address - Street 1:929 N SAINT FRANCIS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-268-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1393581101163W00000X
KS55669367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB033OtherTRICARE 48115896767214
KS200574150AMedicaid
KSP00660633OtherRR MEDICARE GROUP CQ2302
KS200574150AMedicaid