Healthcare Provider Details

I. General information

NPI: 1396227211
Provider Name (Legal Business Name): AMY HULSE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1861 N ROCK RD STE 105
WICHITA KS
67206-1264
US

IV. Provider business mailing address

1861 N ROCK RD STE 105
WICHITA KS
67206-1264
US

V. Phone/Fax

Practice location:
  • Phone: 316-201-1755
  • Fax: 316-201-1138
Mailing address:
  • Phone: 316-201-1755
  • Fax: 316-201-1138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-78239-082
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: