Healthcare Provider Details

I. General information

NPI: 1205627759
Provider Name (Legal Business Name): PAIGE KELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3343 W CENTRAL AVE
WICHITA KS
67203-4917
US

IV. Provider business mailing address

3343 W CENTRAL AVE
WICHITA KS
67203-4917
US

V. Phone/Fax

Practice location:
  • Phone: 316-260-4110
  • Fax:
Mailing address:
  • Phone: 316-260-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-84297-122
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: