Healthcare Provider Details

I. General information

NPI: 1740218262
Provider Name (Legal Business Name): NANCY L ROOP APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 S HYDRAULIC ST
WICHITA KS
67211-1908
US

IV. Provider business mailing address

7329 N WOODLAWN ST
VALLEY CENTER KS
67147-8560
US

V. Phone/Fax

Practice location:
  • Phone: 316-219-3571
  • Fax: 316-219-3573
Mailing address:
  • Phone: 316-219-3571
  • Fax: 316-219-3573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number44194
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number44194
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: