Healthcare Provider Details

I. General information

NPI: 1801893748
Provider Name (Legal Business Name): ANDREA K WILLHITE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 S HWY 59 BLDG E
PARSONS KS
67357-4948
US

IV. Provider business mailing address

1902 S HWY 59 BLDG E STE 101
PARSONS KS
67357-4948
US

V. Phone/Fax

Practice location:
  • Phone: 620-820-5800
  • Fax: 620-820-5589
Mailing address:
  • Phone: 620-820-5800
  • Fax: 620-820-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-28064
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: