Healthcare Provider Details

I. General information

NPI: 1548098536
Provider Name (Legal Business Name): KELSIE HOFFMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/30/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 N WEBB RD
WICHITA KS
67226-8110
US

IV. Provider business mailing address

2626 N WEBB RD
WICHITA KS
67226-8110
US

V. Phone/Fax

Practice location:
  • Phone: 316-636-6100
  • Fax:
Mailing address:
  • Phone: 316-636-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-83439-091
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: