Healthcare Provider Details

I. General information

NPI: 1780132449
Provider Name (Legal Business Name): TRACEY L. SMALL APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W 16TH ST
WELLINGTON KS
67152-8125
US

IV. Provider business mailing address

3460 N RIDGE RD STE 120
WICHITA KS
67205-1223
US

V. Phone/Fax

Practice location:
  • Phone: 620-326-7448
  • Fax: 620-326-6662
Mailing address:
  • Phone: 316-272-0800
  • Fax: 316-272-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-82899-091
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7729
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number53-82899-091
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: