Healthcare Provider Details

I. General information

NPI: 1477003481
Provider Name (Legal Business Name): KAMBRA MAYFIELD AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 N ROCK RD
WICHITA KS
67206-1262
US

IV. Provider business mailing address

1151 N ROCK RD
WICHITA KS
67206-1262
US

V. Phone/Fax

Practice location:
  • Phone: 316-634-3518
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2364
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1779
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: