Healthcare Provider Details

I. General information

NPI: 1124165485
Provider Name (Legal Business Name): GORDON DAVID KUNTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E 7TH ST
HAYS KS
67601-4907
US

IV. Provider business mailing address

208 E 7TH
HAYS KS
67601
US

V. Phone/Fax

Practice location:
  • Phone: 785-628-2871
  • Fax: 785-628-0426
Mailing address:
  • Phone: 785-628-2871
  • Fax: 785-628-0426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13582171111
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number74162
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: