Organization
A-1 IV REHYDRATION CLINIC AND LOUNGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA JACKSON (OWNER)
(316) 377-0462
Entity
Organization
Contact information
Practice address
450 N 159TH ST E, WICHITA, KS 67230-7704
(316) 377-0462
Mailing address
450 N 159TH ST E, WICHITA, KS 67230-7704
(316) 377-0462
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/13/2023
Last updated
04/27/2023
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