Healthcare Provider Details

I. General information

NPI: 1700749819
Provider Name (Legal Business Name): VIRGINIA MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 N PEARCE ST
WICHITA KS
67203-3548
US

IV. Provider business mailing address

1221 N PEARCE ST
WICHITA KS
67203-3548
US

V. Phone/Fax

Practice location:
  • Phone: 785-473-3063
  • Fax:
Mailing address:
  • Phone: 785-473-3063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8942
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: