Provider Demographics
NPI:1154702793
Name:STRACK, RICKAE D (APRN)
Entity type:Individual
Prefix:
First Name:RICKAE
Middle Name:D
Last Name:STRACK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 S LAURA AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-1518
Mailing Address - Country:US
Mailing Address - Phone:316-686-7117
Mailing Address - Fax:316-686-2679
Practice Address - Street 1:347 S LAURA AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-1518
Practice Address - Country:US
Practice Address - Phone:316-686-7117
Practice Address - Fax:316-686-2679
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS76807363LG0600X
KS53-76807-051363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004395370002Medicaid