Healthcare Provider Details

I. General information

NPI: 1386841948
Provider Name (Legal Business Name): KIERSTEN DAWN CAMP ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CESSNA BLVD
WICHITA KS
67215-1400
US

IV. Provider business mailing address

6550 LAZY DAY LN.
ANDALE KS
67001
US

V. Phone/Fax

Practice location:
  • Phone: 316-517-8775
  • Fax: 316-517-8063
Mailing address:
  • Phone: 316-444-2541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number45622
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: