Healthcare Provider Details

I. General information

NPI: 1477467926
Provider Name (Legal Business Name): SARAH JOHNICO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 S EDGEMOOR ST
WICHITA KS
67218-3337
US

IV. Provider business mailing address

6630 W 48TH ST N
WICHITA KS
67205-9232
US

V. Phone/Fax

Practice location:
  • Phone: 316-993-4079
  • Fax:
Mailing address:
  • Phone: 316-990-7165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number111579
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: