Provider Demographics
NPI:1699719203
Name:HUCKSTADT, ALICIA A (PHD, ARNP, FNP)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:A
Last Name:HUCKSTADT
Suffix:
Gender:F
Credentials:PHD, ARNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13303 E. CAMDEN CHASE ST.
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67228-8028
Mailing Address - Country:US
Mailing Address - Phone:316-636-9248
Mailing Address - Fax:
Practice Address - Street 1:1845 FAIRMOUNT ST, BOX 41
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67260-0001
Practice Address - Country:US
Practice Address - Phone:316-978-5742
Practice Address - Fax:316-978-3094
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5344403363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology