Healthcare Provider Details

I. General information

NPI: 1174446827
Provider Name (Legal Business Name): PENNY TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 E MAINSGATE RD
WICHITA KS
67226-1062
US

IV. Provider business mailing address

2509 N WOODRIDGE ST
WICHITA KS
67226-8258
US

V. Phone/Fax

Practice location:
  • Phone: 316-461-7923
  • Fax:
Mailing address:
  • Phone: 864-617-6595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number03559
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: