Healthcare Provider Details

I. General information

NPI: 1013978485
Provider Name (Legal Business Name): COUNTY OF STANTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N MAIN ST
JOHNSON KS
67855-0639
US

IV. Provider business mailing address

114 N MAIN ST BOX 639
JOHNSON KS
67855-0639
US

V. Phone/Fax

Practice location:
  • Phone: 620-492-1400
  • Fax: 620-492-1608
Mailing address:
  • Phone: 620-492-1400
  • Fax: 620-492-1608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHERYL WILKERSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 620-492-1400