Healthcare Provider Details

I. General information

NPI: 1518012673
Provider Name (Legal Business Name): KANSAS NEUROLOGICAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3107 SW 21ST
TOPEKA KS
66604-3245
US

IV. Provider business mailing address

3107 SW 21ST
TOPEKA KS
66604-3245
US

V. Phone/Fax

Practice location:
  • Phone: 785-296-5301
  • Fax: 785-296-0707
Mailing address:
  • Phone: 785-296-5301
  • Fax: 785-296-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1353996081
License Number StateKS

VIII. Authorized Official

Name: BRENT WIDICK
Title or Position: SUPERINTENDENT
Credential:
Phone: 785-296-5301