Healthcare Provider Details

I. General information

NPI: 1316741788
Provider Name (Legal Business Name): TRINITY K BOGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N KANSAS ST
WICHITA KS
67214-3124
US

IV. Provider business mailing address

422 UTAH RD
GREELEY KS
66033-9550
US

V. Phone/Fax

Practice location:
  • Phone: 316-293-2653
  • Fax:
Mailing address:
  • Phone: 785-304-2930
  • Fax: 785-304-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number94-12871
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2026025932
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: