Healthcare Provider Details

I. General information

NPI: 1144144320
Provider Name (Legal Business Name): DONITA KAYELON ERNEST-DUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 MAPLE ST
COFFEYVILLE KS
67337-4814
US

IV. Provider business mailing address

486 ROAD 28
PERU KS
67360-9045
US

V. Phone/Fax

Practice location:
  • Phone: 620-515-1907
  • Fax:
Mailing address:
  • Phone: 620-515-1907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number05357
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: