Basic Information
| Provider Information | |||||||||
| NPI: | 1497720981 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THIESSEN | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 N. KANSAS | ||||||||
| Address2: | SUITE #3049 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162931840 | ||||||||
| FaxNumber: | 3162931882 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 N MINNEAPOLIS ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162931840 | ||||||||
| FaxNumber: | 3162932670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2006 | ||||||||
| LastUpdateDate: | 01/11/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 74700 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.