Provider Demographics
NPI:1992108443
Name:WETTA, K.C. LOWRANCE (APRN)
Entity type:Individual
Prefix:
First Name:K.C.
Middle Name:LOWRANCE
Last Name:WETTA
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 1:10100 E SHANNON WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4104
Mailing Address - Country:US
Mailing Address - Phone:316-219-8299
Mailing Address - Fax:
Practice Address - Street 1:10100 E SHANNON WOODS CIR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4104
Practice Address - Country:US
Practice Address - Phone:316-219-8299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS103471163W00000X
KS149783363L00000X
KS76538363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse