Provider Demographics
NPI:1730832593
Name:GEMAEHLICH, MEKAYLA (APRN)
Entity type:Individual
Prefix:
First Name:MEKAYLA
Middle Name:
Last Name:GEMAEHLICH
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 1:2703 CUNNINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-8426
Mailing Address - Country:US
Mailing Address - Phone:620-255-9940
Mailing Address - Fax:
Practice Address - Street 1:1513 W WYATT EARP BLVD
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-3352
Practice Address - Country:US
Practice Address - Phone:620-682-8304
Practice Address - Fax:620-682-8305
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80890-032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily