Provider Demographics
NPI:1275542359
Name:YASSINE, CHARLA (ARNP)
Entity type:Individual
Prefix:
First Name:CHARLA
Middle Name:
Last Name:YASSINE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S CLIFTON AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2958
Mailing Address - Country:US
Mailing Address - Phone:316-274-8989
Mailing Address - Fax:
Practice Address - Street 1:1515 S CLIFTON AVE STE 205
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2958
Practice Address - Country:US
Practice Address - Phone:316-274-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-06
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-74259363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201982OtherHPK
KS160538OtherBCBS
KS201982OtherPHS
KS201982OtherPHS
KS160538OtherBCBS