Individual
WENDI L TILSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
550 N HILLSIDE ST, WICHITA, KS 67214-4910
(316) 962-3150
(316) 962-7334
Mailing address
PO BOX 47490, WICHITA, KS 67201-7490
(316) 962-3150
(316) 962-7334
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-00820
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
426844
BLUE CROSS BLUE SHIELD
KS
01
—
430030
FIRSTGUARD
KS
Enumeration date
03/16/2006
Last updated
07/08/2007
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