Healthcare Provider Details

I. General information

NPI: 1245144799
Provider Name (Legal Business Name): NICOLE CUNNINGHAM
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

2820 S ROOSEVELT ST
WICHITA KS
67210-1419
US

IV. Provider business mailing address

2820 S ROOSEVELT ST
WICHITA KS
67210-1419
US

V. Phone/Fax

Practice location:
  • Phone: 316-973-9322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number13-144505-071
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: