Healthcare Provider Details

I. General information

NPI: 1871430421
Provider Name (Legal Business Name): HEARTLAND WELLNESS MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 W MAIN ST
CHANUTE KS
66720-1607
US

IV. Provider business mailing address

421 W MAIN ST
CHANUTE KS
66720-1607
US

V. Phone/Fax

Practice location:
  • Phone: 620-431-7193
  • Fax: 620-431-7741
Mailing address:
  • Phone: 620-431-7193
  • Fax: 620-431-7741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH NOTHERN
Title or Position: OWNER/PROVIDER
Credential: DMSC, PA-C
Phone: 620-431-7193