Healthcare Provider Details

I. General information

NPI: 1538166228
Provider Name (Legal Business Name): SONDRA J KRAYCA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 MAIN ST
GOODLAND KS
67735-2941
US

IV. Provider business mailing address

910 MAIN ST
GOODLAND KS
67735-2941
US

V. Phone/Fax

Practice location:
  • Phone: 785-890-7950
  • Fax: 785-890-7951
Mailing address:
  • Phone: 785-890-7950
  • Fax: 785-890-7951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number74225
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: