Healthcare Provider Details

I. General information

NPI: 1740233204
Provider Name (Legal Business Name): PRATT FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 WATSON ST SUITE 200
PRATT KS
67124-3066
US

IV. Provider business mailing address

203 WATSON ST SUITE 200
PRATT KS
67124-3066
US

V. Phone/Fax

Practice location:
  • Phone: 620-672-7422
  • Fax: 620-508-6476
Mailing address:
  • Phone: 620-672-7422
  • Fax: 620-508-6476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WAKON FOWLER
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 620-672-7422