Provider Demographics
NPI:1952026791
Name:WHEELER, KARA MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:MARIE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:KARA
Other - Middle Name:MARIE
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3626 E 3920 N
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:ID
Mailing Address - Zip Code:83341-5114
Mailing Address - Country:US
Mailing Address - Phone:719-313-6439
Mailing Address - Fax:
Practice Address - Street 1:3626 E 3920 N
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:ID
Practice Address - Zip Code:83341-5114
Practice Address - Country:US
Practice Address - Phone:719-313-6439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID59771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily