Healthcare Provider Details

I. General information

NPI: 1730415977
Provider Name (Legal Business Name): KATHY BRACE CPM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10002 E LINCOLN ST
WICHITA KS
67207-3942
US

IV. Provider business mailing address

10002 E LINCOLN ST
WICHITA KS
67207-3942
US

V. Phone/Fax

Practice location:
  • Phone: 316-682-0903
  • Fax: 316-682-0903
Mailing address:
  • Phone: 316-682-0903
  • Fax: 316-682-0903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateKS

VIII. Authorized Official

Name: KATHY ANN BRACE
Title or Position: PRESIDENT
Credential: CPM
Phone: 316-682-0903