Healthcare Provider Details

I. General information

NPI: 1407735897
Provider Name (Legal Business Name): MADISON BEHRENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 E 29TH ST N STE 204
WICHITA KS
67226-2183
US

IV. Provider business mailing address

9300 E 29TH ST N STE 204
WICHITA KS
67226-2183
US

V. Phone/Fax

Practice location:
  • Phone: 316-500-6000
  • Fax:
Mailing address:
  • Phone: 316-500-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number15-03330
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: