Healthcare Provider Details

I. General information

NPI: 1972570976
Provider Name (Legal Business Name): KRISTY KUNKEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 N 2ND ST
ATCHISON KS
66002-1203
US

IV. Provider business mailing address

1412 N 2ND ST
ATCHISON KS
66002-1203
US

V. Phone/Fax

Practice location:
  • Phone: 913-367-4879
  • Fax:
Mailing address:
  • Phone: 913-367-4879
  • Fax: 913-367-0240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3722
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100288780D
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: