Healthcare Provider Details

I. General information

NPI: 1548906134
Provider Name (Legal Business Name): CHRISTOPHER RAY THIEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2022
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E 23RD AVE
HUTCHINSON KS
67502-9907
US

IV. Provider business mailing address

936 N REDBUD CT
VALLEY CENTER KS
67147-3215
US

V. Phone/Fax

Practice location:
  • Phone: 620-513-4850
  • Fax: 620-513-4851
Mailing address:
  • Phone: 785-512-0248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-02652
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: