Healthcare Provider Details

I. General information

NPI: 1629281373
Provider Name (Legal Business Name): COUNTY OF SEDGWICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 W CENTRAL AVE
WICHITA KS
67203-4904
US

IV. Provider business mailing address

635 N MAIN ST
WICHITA KS
67203-3602
US

V. Phone/Fax

Practice location:
  • Phone: 316-660-7354
  • Fax: 316-660-4918
Mailing address:
  • Phone: 316-660-7611
  • Fax: 316-660-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1500365
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1500685
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number45204
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number45073
License Number StateKS
# 5
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CLAUDIA BLACKBURN
Title or Position: HEALTH DEPARTMENT DIRECTOR
Credential:
Phone: 316-660-7339