Healthcare Provider Details

I. General information

NPI: 1477926301
Provider Name (Legal Business Name): PRAIRIE HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12115 E 21ST ST N STE 107
WICHITA KS
67206-3571
US

IV. Provider business mailing address

12115 E 21ST ST N STE 107
WICHITA KS
67206-3571
US

V. Phone/Fax

Practice location:
  • Phone: 316-440-7000
  • Fax: 316-440-7006
Mailing address:
  • Phone: 316-440-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number2100037
License Number StateKS

VIII. Authorized Official

Name: LAURA JOHNSTON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 316-440-7000