Provider Demographics
NPI:1699151936
Name:WOLFF, KENDRA ROSE (APRN)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:ROSE
Last Name:WOLFF
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 1:141 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3848
Mailing Address - Country:US
Mailing Address - Phone:316-660-0850
Mailing Address - Fax:
Practice Address - Street 1:141 W ELM ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3848
Practice Address - Country:US
Practice Address - Phone:316-660-0850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS76529363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health