MEDICARE: VETA PSYCHIATRIC CARE LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1740131952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VETA PSYCHIATRIC CARE LLC

Provider Business Mailing Address
First Line	:	9404 W WYNCROFT ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-3403
Country	:	US
Telephone Number	:	316-641-3644
Fax Number	:

Provider Business Practice Location Address
First Line	:	9404 W WYNCROFT ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-3403
Country	:	US
Telephone Number	:	316-641-3644
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JESSICA E MOYER
Credential	:	APRN
Telephone Number	:	316-641-3644

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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