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NPI Code Detail

MEDICARE: GERALD E NIERNBERGER DO

MEDICARE: GERALD E NIERNBERGER DO
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
1207Q00000XFamily Medicine Physician207Q00000XKS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1014394OTHERKSBCBS
216858OTHERKSCOVENTRY
3100302OTHERKSHPK
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
512149386OTHERKSMULTIPLAN
6681OTHERKSPHS

General Provider Information

NPI Number : 1417986894
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERALD E NIERNBERGER DO
Provider Business Mailing Address
First Line : PO BOX 8035
Second Line :
City : WICHITA
State : KS
Zip : 67208-0035
Country : US
Telephone Number : 316-689-9135
Fax Number : 316-689-9102
Provider Business Practice Location Address
First Line : 14700 W SAINT TERESA ST STE 300
Second Line :
City : WICHITA
State : KS
Zip : 67235-9630
Country : US
Telephone Number : 316-274-0142
Fax Number : 316-719-1021
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 01/09/2023

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Directions to “ GERALD E NIERNBERGER DO” Practice Location

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