MEDICARE: CORESIA LASHON KIRKENDOLL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1144964552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORESIA LASHON KIRKENDOLL

Provider Business Mailing Address
First Line	:	2758 N WELLESLEY AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67220-2408
Country	:	US
Telephone Number	:	316-871-8253
Fax Number	:

Provider Business Practice Location Address
First Line	:	2758 N WELLESLEY AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67220-2408
Country	:	US
Telephone Number	:	316-871-8253
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2022
Last Update Date	:	04/21/2022

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Directions to “ CORESIA LASHON KIRKENDOLL ” Practice Location

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