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NPI Code Detail

MEDICARE: ANGELA MICHELLE THEOBALD

MEDICARE: ANGELA MICHELLE THEOBALD
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner77752KS
2363LF0000XFamily Nurse Practitioner53-77752KS

General Provider Information

NPI Number : 1427570373
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA MICHELLE THEOBALD
Provider Business Mailing Address
First Line : 1122 N TOPEKA ST
Second Line :
City : WICHITA
State : KS
Zip : 67214-2810
Country : US
Telephone Number : 316-866-2000
Fax Number :
Provider Business Practice Location Address
First Line : 1919 N AMIDON AVE STE 100
Second Line :
City : WICHITA
State : KS
Zip : 67203-2118
Country : US
Telephone Number : 316-866-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2017
Last Update Date : 02/13/2026

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Directions to “ ANGELA MICHELLE THEOBALD ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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