Healthcare Provider Details

I. General information

NPI: 1063969392
Provider Name (Legal Business Name): BRYNN EKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9426 PFLUMM RD
LENEXA KS
66215-3308
US

IV. Provider business mailing address

17290 S AGNES ST
GARDNER KS
66030-9452
US

V. Phone/Fax

Practice location:
  • Phone: 913-608-7005
  • Fax:
Mailing address:
  • Phone: 417-693-2341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA00489
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: