Healthcare Provider Details

I. General information

NPI: 1922842863
Provider Name (Legal Business Name): WHITTERS WORLD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 W CENTRAL AVE STE 106
WICHITA KS
67212-6302
US

IV. Provider business mailing address

1004 W WALLINGFORD ST
WICHITA KS
67217-5742
US

V. Phone/Fax

Practice location:
  • Phone: 316-945-5200
  • Fax:
Mailing address:
  • Phone: 316-285-3974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: WHITNEY RENAE BANISTER
Title or Position: SOLE PROPRIETER
Credential: LMSW
Phone: 316-285-3974