Healthcare Provider Details

I. General information

NPI: 1144075615
Provider Name (Legal Business Name): CROOKED CREEK MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 COMMERCIAL ST
ATCHISON KS
66002-2418
US

IV. Provider business mailing address

13818 FRONT ST
CUMMINGS KS
66016-9186
US

V. Phone/Fax

Practice location:
  • Phone: 575-361-5646
  • Fax:
Mailing address:
  • Phone: 575-361-5646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NANCY D BRADER
Title or Position: CEO
Credential: PMHNP
Phone: 913-395-7626