Healthcare Provider Details

I. General information

NPI: 1700844115
Provider Name (Legal Business Name): CHRISTINE DARBY FUSSELL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 S CLIFTON
WICHITA KS
67218-3718
US

IV. Provider business mailing address

1624 N ROCK RD
DERBY KS
67037-3718
US

V. Phone/Fax

Practice location:
  • Phone: 316-866-2000
  • Fax:
Mailing address:
  • Phone: 316-554-2126
  • Fax: 316-554-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number45630
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-45630-082
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-589920-082
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: