Healthcare Provider Details

I. General information

NPI: 1174513469
Provider Name (Legal Business Name): LINDA S BAYLESS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E KELLOGG DR
WICHITA KS
67218-1607
US

IV. Provider business mailing address

5500 E KELLOGG DR VA MEDICAL CENTER
WICHITA KS
67218-1607
US

V. Phone/Fax

Practice location:
  • Phone: 316-685-3313
  • Fax:
Mailing address:
  • Phone: 316-685-3313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number45694
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: