Healthcare Provider Details

I. General information

NPI: 1194885798
Provider Name (Legal Business Name): BRYAN K HOUCHENS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N B ST
HERINGTON KS
67449-1600
US

IV. Provider business mailing address

100 E HELEN ST
HERINGTON KS
67449-1606
US

V. Phone/Fax

Practice location:
  • Phone: 785-258-5130
  • Fax: 785-258-5129
Mailing address:
  • Phone: 785-258-2207
  • Fax: 785-258-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: