Healthcare Provider Details

I. General information

NPI: 1396048906
Provider Name (Legal Business Name): COLBY P SHINKLE PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4722 W KELLOGG DR
WICHITA KS
67209-2508
US

IV. Provider business mailing address

3018 N ROCK BRIDGE ST
DERBY KS
67037-8780
US

V. Phone/Fax

Practice location:
  • Phone: 316-440-2565
  • Fax:
Mailing address:
  • Phone: 316-640-2791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: