Healthcare Provider Details

I. General information

NPI: 1548704091
Provider Name (Legal Business Name): JUDY MUIRURI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E 23RD AVE
HUTCHINSON KS
67502-9907
US

IV. Provider business mailing address

1701 E 23RD AVE
HUTCHINSON KS
67502-1105
US

V. Phone/Fax

Practice location:
  • Phone: 620-513-4850
  • Fax:
Mailing address:
  • Phone: 620-513-4850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-03133
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-02351
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: