Healthcare Provider Details

I. General information

NPI: 1629834650
Provider Name (Legal Business Name): BARBARA CATHERINE WYSS OMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N TYLER RD STE 100
WICHITA KS
67212-3726
US

IV. Provider business mailing address

3259 N WOODLAND ST
WICHITA KS
67204-4322
US

V. Phone/Fax

Practice location:
  • Phone: 316-210-4030
  • Fax:
Mailing address:
  • Phone: 316-210-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number10989
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: