Provider Demographics
NPI:1861424566
Name:REDDEN, MICHELLE KAY (RPA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KAY
Last Name:REDDEN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 E HARRY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-3713
Mailing Address - Country:US
Mailing Address - Phone:316-858-0333
Mailing Address - Fax:316-858-0596
Practice Address - Street 1:3600 E HARRY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3713
Practice Address - Country:US
Practice Address - Phone:316-858-0333
Practice Address - Fax:316-858-0596
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00592363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098120AMedicaid
KS100360770BMedicaid