Healthcare Provider Details

I. General information

NPI: 1154305308
Provider Name (Legal Business Name): CORINNE CAROL KEHRBERG RN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORINNE CAROL IGNARSKI RN

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7570 W 21ST ST N SUITE 1026-D
WICHITA KS
67205-1734
US

IV. Provider business mailing address

7570 W 21ST ST N SUITE 1026-D
WICHITA KS
67205-1734
US

V. Phone/Fax

Practice location:
  • Phone: 316-729-6555
  • Fax: 316-634-4794
Mailing address:
  • Phone: 316-729-6555
  • Fax: 316-634-4794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1433388041
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number74516
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: