Provider Demographics
NPI:1104896992
Name:OELGER, CHARISE R (PA)
Entity type:Individual
Prefix:
First Name:CHARISE
Middle Name:R
Last Name:OELGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 969
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-0969
Mailing Address - Country:US
Mailing Address - Phone:620-786-6475
Mailing Address - Fax:620-786-6155
Practice Address - Street 1:3520 LAKIN AVE
Practice Address - Street 2:STE 103
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3660
Practice Address - Country:US
Practice Address - Phone:620-792-3345
Practice Address - Fax:620-792-3767
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1500925363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200000640DMedicaid
KSKA2922002Medicare PIN
P96762Medicare UPIN
KS110708008Medicare PIN