Provider Demographics
NPI:1811986821
Name:BEEBE, WANDA SUE (APRN-C)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:SUE
Last Name:BEEBE
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:MRS
Other - First Name:WANDA
Other - Middle Name:SUE
Other - Last Name:BOKOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-C
Mailing Address - Street 1:9505 W CENTRAL AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3832
Mailing Address - Country:US
Mailing Address - Phone:316-312-0002
Mailing Address - Fax:316-854-5644
Practice Address - Street 1:9505 W CENTRAL AVE
Practice Address - Street 2:STE 104
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3832
Practice Address - Country:US
Practice Address - Phone:316-312-0002
Practice Address - Fax:316-854-5644
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44143363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100249040BMedicaid
KSKA2300015Medicare PIN
KS100249040BMedicaid