Healthcare Provider Details

I. General information

NPI: 1821927427
Provider Name (Legal Business Name): TRUFORM HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

511 S MALCOLM AVE
CHANUTE KS
66720-2341
US

IV. Provider business mailing address

511 S MALCOLM AVE
CHANUTE KS
66720-2341
US

V. Phone/Fax

Practice location:
  • Phone: 316-803-0871
  • Fax: 620-202-6570
Mailing address:
  • Phone: 316-803-0871
  • Fax: 620-202-6570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BLAIR WATKINS
Title or Position: OWNER/PROVIDER
Credential: DNP, APRN, FNP-C
Phone: 316-803-0871