Healthcare Provider Details

I. General information

NPI: 1629331962
Provider Name (Legal Business Name): MICHA S KESSLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 WATSON SUITE 200
PRATT KS
67124
US

IV. Provider business mailing address

PO BOX 308
PRATT KS
67124
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 TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-75691-081
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: