Healthcare Provider Details

I. General information

NPI: 1992657100
Provider Name (Legal Business Name): BREANNA AFFALTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BREANNA INMAN

II. Dates (important events)

Enumeration Date: 02/10/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W 8TH ST
LAWRENCE KS
66044-2608
US

IV. Provider business mailing address

2937 KENSINGTON RD
LAWRENCE KS
66046-5452
US

V. Phone/Fax

Practice location:
  • Phone: 913-608-1439
  • Fax:
Mailing address:
  • Phone: 913-585-5579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13983
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: