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NPI Code Detail

MEDICARE: MR. KEVIN E HARTLEY LMSW

MEDICARE:  MR. KEVIN E HARTLEY  LMSW
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
1104100000XSocial Worker1835KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1389922OTHERKSBLUE CROSS BLUE SHIELD
24217OTHERKSPREFERRED PLUS OF KANSAS

General Provider Information

NPI Number : 1780635177
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN E HARTLEY LMSW
Provider Business Mailing Address
First Line : 635 N MAIN ST
Second Line :
City : WICHITA
State : KS
Zip : 67203-3602
Country : US
Telephone Number : 316-660-7600
Fax Number : 316-383-7925
Provider Business Practice Location Address
First Line : 940 N WACO AVE
Second Line :
City : WICHITA
State : KS
Zip : 67203-3947
Country : US
Telephone Number : 316-660-7550
Fax Number : 316-383-8241
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 07/08/2007

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Directions to “ MR. KEVIN E HARTLEY LMSW” Practice Location

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