Healthcare Provider Details

I. General information

NPI: 1003811399
Provider Name (Legal Business Name): NORMAN KEITH TREVOLT ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 02/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 N. ST FRANCIS STE 3901
WICHITA KS
67214-3858
US

IV. Provider business mailing address

848 N. ST FRANCIS STE 3901
WICHITA KS
67214-3858
US

V. Phone/Fax

Practice location:
  • Phone: 316-268-8500
  • Fax: 316-291-7993
Mailing address:
  • Phone: 316-268-8500
  • Fax: 316-291-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number44097
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: