Healthcare Provider Details

I. General information

NPI: 1346379625
Provider Name (Legal Business Name): PRATT FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 03/07/2012
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: 620-450-1601
Mailing address:
  • Phone: 620-672-7422
  • Fax: 620-450-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number178987
License Number StateKS

VIII. Authorized Official

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