Healthcare Provider Details

I. General information

NPI: 1497520506
Provider Name (Legal Business Name): KAW VALLEY WELLNESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SE GOLF PARK BLVD # 120
TOPEKA KS
66605-2862
US

IV. Provider business mailing address

455 SE GOLF PARK BLVD # 120
TOPEKA KS
66605-2862
US

V. Phone/Fax

Practice location:
  • Phone: 785-228-2346
  • Fax: 785-228-2337
Mailing address:
  • Phone: 785-228-2346
  • Fax: 785-228-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRISHA OSIER-DUVALL
Title or Position: COMMUNITY HEALTH ADVOCATE
Credential:
Phone: 785-228-2346