Healthcare Provider Details

I. General information

NPI: 1992173678
Provider Name (Legal Business Name): PRATT FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 WATSON ST SUITE 200
PRATT KS
67124-3068
US

IV. Provider business mailing address

203 WATSON ST SUITE 200
PRATT KS
67124-3068
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: MRS. AMY SCHRAG
Title or Position: OFFICE MANAGER
Credential:
Phone: 620-672-7422