Healthcare Provider Details

I. General information

NPI: 1295809192
Provider Name (Legal Business Name): FINNIAN CHRISTOPHER MCCULLOUGH ARNP, MS, BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MAINE ST STE A
LAWRENCE KS
66044
US

IV. Provider business mailing address

200 MAINE ST STE A
LAWRENCE KS
66044-1396
US

V. Phone/Fax

Practice location:
  • Phone: 785-843-9192
  • Fax: 785-843-2219
Mailing address:
  • Phone: 785-843-9192
  • Fax: 785-843-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number74550
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: