Individual
JODENE R. THACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
7200 W 13TH ST N, SUITE 5, WICHITA, KS 67212-2970
(316) 239-7357
(316) 295-2356
Mailing address
7200 W 13TH ST N, SUITE 5, WICHITA, KS 67212-2970
(316) 217-6367
(316) 295-2356
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
CNP00557
NM
363LF0000X
Family Nurse Practitioner
36827
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201091430A
—
KS
05
—
L6477
—
NM
Enumeration date
11/11/2005
Last updated
09/23/2014
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