Healthcare Provider Details

I. General information

NPI: 1023352374
Provider Name (Legal Business Name): WESTERN PLAINS PHYSICIAN PRACTICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 NORTH MAIN STREET
CIMARRON KS
67835
US

IV. Provider business mailing address

PO BOX 728
DODGE CITY KS
67801-0728
US

V. Phone/Fax

Practice location:
  • Phone: 620-855-4456
  • Fax: 620-855-4459
Mailing address:
  • Phone: 620-855-4456
  • Fax: 620-855-4459

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: JESS N JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-372-8500