Individual
KYLIE KRISTINE WITHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1923 N WEBB RD, WICHITA, KS 67206-3405
(316) 630-9300
(316) 262-4887
Mailing address
1923 N WEBB RD, WICHITA, KS 67206-3405
(316) 630-9300
(316) 262-4887
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-00877
KS
363AM0700X
Medical Physician Assistant
15-00877
KS
Other
Enumeration date
11/14/2006
Last updated
10/09/2009
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